Osteoclastoma Symphysis Menti, A Case Report.

A case report of a rare Head & Neck Tumor, presented at Pakistan Institute of Medical Sciences, Islamabad. A 3 year old girl presented with a progressively enlarging swelling over the chin for 2months.
O/E: A huge swelling in the region of symphysis menti ,extending to involve the floor of the mouth , pushing the tongue upwards and backwards
No clinically palpable neck nodes. All baseline investigations were within normal range. After a proper Diagnosis made on Ct Scans and Histopathology, A Midline Mandibulectomy by vertical median lip splitting by an inverted T shaped incision was done.Titanium plates were used to stabilize the free edges of the mandible on both sides
Soft tissue reconstruction was done by primary closure.
Wound healed within 2 weeks post-operatively without any complications.

2. “OSTEOCLASTOMA
SYMPHYSIS MENTI”
A CASE REPORT
Prof. Anjum Khawar
Dr. Riffat Rehman Khattak
ENT PIMS ISLAMABAD

4. INTRODUCTION

5. OSTEOCLASTOMA SYMPHYSIS MENTI
(INTRODUCTION)
►An uncommon, benign intra-osseous lesion of the bones
►Constitutes about 4-9.5% of all the bony tumors
►A typically benign and a solitary tumor
►Multiple lesions have been described aswell, accounting
for <1% of all cases of Giant Cell Tumors
Alessandro L, Luigi L, Letizia P, Antonio DE & Nicole C. Clinical Practice: Giant Cell Tumor of the Jaw mimicking bone
malignancy on a 3D reconstruction .open dent J.2008;2:73-77

6. OSTEOCLASTOMA SYMPHYSIS MENTI
(INTRODUCTION)
►5-10% of the lesions may be malignant
►Usually involves the long bones
►Less commonly involved are the jaw bones, vertebral
bodies and the wrist
►Head and neck region is quite an unusual site of
occurrence of Osteoclastoma
Alessandro L, Luigi L, Letizia P, Antonio DE & Nicola C .Clinical Practice: Giant Cell Tumor of the jaw mimicking bone
malignancy on a 3D Reconstruction CT .open dent. J. 2008;2. 73-77

7. OSTEOCLASTOMA SYMPHYSIS MENTI
(INTRODUCTION)
►Most commonly reported b/w 20-40 years of age
►Peak age of incidence is the 3
rd
decade of life
►Male to female ratio ranging from 1.4:3
►Incidence of GCT in H&N=5-6%
►Incidence of GCT in maxilla=29%
►Incidence of GCT in mandible=68%
R. Tamirkulu, B. Erol, U.Yilmaz,F.Yaman,S.Atilgan.Central Giant Cell lesions of the Jaws in children. Review of 34 cases; 21 ;
211-214 ; 2007

8. OSTEOCLASTOMA SYMPHYSIS MENTI
(INTRODUCTION)
►Incidenceof GCT in Symphysis Menti=57%
►Incidence of GCT in other parts of Mandible=43%
R .Tamirkulu, B. Erol ,U. Yilmaz , F. Yaman ,S. atilgan. Central Giant Cell Lesions (CGCL) of the Jaws in children.
The review of 34 cases; 21 : 211-214 ; 2007

9. OSTEOCLASTOMA SYMPHYSIS MENTI
(DEMOGRAPHY)
K.Unni, Carrie Y.I-Giant Cell Tumor (osteoclastoma) In: Dahlin’s Bone Tumors-6
th
ed. Lippincott Williams, Wikkins, 19: 226
;2009

10. K. Unni, Carrie Y.I-Giant cell Tumor (osteoclastoma) In: Dahlin’s Bone Tumors-6
th
ed. Lippincott Williams ,Wikkins, 19 ;p226 ;
2009

11. OSTEOCLASTOMA SYMPHYSIS MENTI
(CLINICAL STAGING)
►STAGE 1: The Latent Stage
( destruction of the outer surface of bone )
►STAGE 2: The Active Stage
( loss of the cortical bone )
►STAGE 3: The Aggressive Stage
(extension of the tumor into the soft tissues)
Blackley , H.R., et al. “ Treatment of Giant Cell Tumors with Curettage and Bone Grafting” . Journal of Bone & Joint Surgery
American, 81, no.6 (2001) : 811-20

12. OSTEOCLASTOMA SYMPHYSIS MENTI
(DIAGNOSIS)
►The Diagnosis is based upon:
1-OPG findings
2-Typical CT findings
3-HistopathologicalFeatures
Henry L Jaffe Lecture. Giant Cell Tumor (osteoclastoma) of Bone : Its pathological delimitation and the inherent clinical
complications. 9
th
June 1953. Royal College of Surgeons England

13. OSTEOCLASTOMA SYMPHYSIS MENTI
(SURGICAL OPTIONS)
►Primary resection & reconstruction with Titanium Plates
►Curettage
►Curettage with bone grafting
Malik NA: Textbook of Oral and Maxillofacial Surgery.2
nd
ed. Jaypee brothers Publishers,2008

14. OSTEOCLASTOMA SYMPHYSIS MENTI
(DIFFERENTIAL DIAGNOSES)
►Giant Cell Granuloma
►Fibrosseous lesion
►Aneurysmal bone cyst
►Odontogenic Myxoma
►Vascular Bone Lesion
►Keratocystic Odontogenic Tumor
►Sarcoma
►Langhan Cell Histiocytosis
Alessandro L, Luigi L, Letizia P, Antonio DE & Nicola C. Clinical practice :Giant Cell Tumor of the Jaw mimicking bone
malignancy on a 3D CT reconstruction. Open Dent J.2008 ;2, 73-77

15. CASE
PRESENTATION

16. OSTEOCLASTOMA SYMPHYSIS MENTI
(CASE REPORT)
►Patient’s name: Laiba
►Age: 3 yrs
►Presented with a progressively enlarging swelling over
the chin-2months
►O/E: A huge swelling in the region of symphysis menti
,extending to involve the floor of the mouth , pushing
thetongue upwards and backwards
►No palpable neck nodes

17. OSTEOCLASTOMA SYMPHYSIS MENTI
(CASE REPORT)

18. DIAGNOSIS

19. OSTEOCLASTOMA SYMPHYSIS MENTI
(RADIOLOGICAL FEATURES)

21. ►Typical bearded
appearance
►Sun-ray appearance
►Bony spicules due to
osteolysis

22. OSTEOCLASTOMA SYMPHYSIS MENTI
(HISTOPATHOLOGY)
►Revealed Multinucleate Giant Cells scattered randomly
throughout the fibro-vascular stroma
►The Giant cells were multinucleated with bland
appearing nucleiand the background stromal cells
displayed mild to moderate atypia

23. OSTEOCLASTOMA SYMPHYSIS MENTI
(HISTOPATHOLOGY)

24. MANAGEMENT

25. OSTEOCLASTOMA SYMPHYSIS MENTI
(MANAGEMENT)
►Midline mandibulectomy by vertical median lip splitting
by an inverted T shaped incision was done
►Titanium plates were used to stablize the free edges of
the mandible on both sides by the OMFS department
►Soft tissue reconstructionwas done by primary closure
►Wound healed within 2 weeks post-operatively without
any complications

26. MANAGEMENT
Midline mandibulectomy by vertical median Lip
splitting by an inverted T shaped incision
Titanium plates were used to stabilize the free
edges of mandible on both sides by OMFS Deptt.
Soft tissue reconstruction done by primary closure
Wound healed without any complications in two
weeks postoperatively

28. AFTER TUMOR EXCISION

29. TITANIUM PLATES

31. OSTEOCLASTOMA SYMPHYSIS MENTI
(CONCLUSION)
A case of osteoclastoma in an unexpected age
group , at an unusual site ,if diagnosed and
managed accurately results in an acceptable
outcome

32. OSTEOCLASTOMA SYMPHYSIS MENTI
(REFERENCES)
►Mendenhall WM,Zlotecki RA,Scarborough MT, Gibbs CP, Mendenhall NP,Giant
cell tumour of the bone.Am j Clin Oncol.2006;96-9[PubMed
►Faisham WI,ZulmiW,Halim AS,Biswal BM,Mutum SS,Ezane AM.Agressive giant
cell tumour of bone.Singapore Med J.2006;47:679-83.[PubMed
►Tobon-Arroyave SI,Franco-Gonzalez LM,Isaza Guzman DM,Florez-Moreno
GA,Bravo-Vasquez T,Castaneda-PelaezDA.Vieco-Duran.Immunohistochemical
exoression of RANK GRalphaand CTR in central giant cell tumour of the
jaws.Oral oncol.2005;41;480-8[PubMed
►Cai G,Ramdall R,Garcia R,Levine P.Pulmonary metastasis of Giant Cell Tumour of the bone
diagnosed by Fine needle aspiration Biopsy.Diagn Cytopathol.2007;35:358-62[PubMed]
►Regezi JA,Odontogenic Cysts and Odontogenic Tumours, fibrosseous and Giant Cell lesions
of the Jaws.Mod Pathol.2002;15:331-41[PubMed

33. OSTEOCLASTOMA SYMPHYSIS MENTI
(REFERENCES)
►Cooper AS Travers B.Surgical Essays.London England.Cox Longman &
Co.1818;178-9
►Dahlin DC,Caldwell Lecture Giant Cell Tumour of Bone:highlights of 407
cases.AJR AMJ Roentogenol May 1985:144(5):955-65
►Dziukowa J:Giant Cell Tumours of Jaw bones.Novotomory,24(3):173-180,1974
►Csiba A: Giant Cell Tumours of Mandible Fogorv.Sz,75:289-295,198
►Ajagbe H.A; Samuel 1; and Daramita JO: Giant Cell Tumors of Maxilla; Report of
a case-oral Surgery.46:759-764;1978

34. THANK
YOU