25370695 Visualization

A 46 Age - year Age - old Age Caucasian Personal_background woman Sex of Ashkenazi Personal_background Jewish Personal_background descent presented Activity with the chief complaint of severe Severity and constant Detailed_description throbbing Detailed_description pain Sign_symptom in her left Biological_structure posterior Biological_structure mandible Biological_structure .
She reported that her pain Sign_symptom was aggravated by chewing Activity , and started months Date before Date the initial consultation Clinical_event visit.
Visual Diagnostic_procedure analog Diagnostic_procedure scale Diagnostic_procedure of Diagnostic_procedure pain Diagnostic_procedure was reported 7/10 Quantitative_concept at the day Date of Date the Date visit Date .
Past medical history was remarkable for Gaucher Disease_disorder disease Disease_disorder , left Biological_structure hip Biological_structure replacement History , gall Biological_structure bladder Biological_structure removal History , herniorrhaphy History , spleen Biological_structure abscess History drainage History , hepatitis Disease_disorder C Disease_disorder infection Disease_disorder , and asthma Disease_disorder .
Social history was significant for 20 Quantitative_concept pack Quantitative_concept - years Quantitative_concept of cigarette Activity smoking Activity .
Her family history was unremarkable Family_history for Family_history any Family_history hereditary Family_history or Family_history systemic Family_history diseases Family_history .
Her medications included the oral Administration antiresorptive Detailed_description drug alendronate Medication for early osteoporosis Disease_disorder associated with Gaucher Disease_disorder disease Disease_disorder ( 70mg Dosage weekly Dosage for 2 Duration years Duration ), calcium Medication supplements Medication , loratadine Medication , hydromorphone Medication , esomeprazole Medication , promethazine Medication , levalbuterol Medication , carisoprodol Medication , fluticasone Medication and ibuprofen Medication .
She reported that she had been on enzyme Medication replacement Medication therapy Medication ( ERT Medication ) intermittently Frequency for several Duration years Duration to treat her Gaucher Disease_disorder disease Disease_disorder which History was History diagnosed History 20 Date years Date prior Date .
She received intravenous Administration injections Administration twice Frequency a Frequency month Frequency for ERT Coreference and recounted fatigue Sign_symptom after each infusion.
She also reported receiving antibiotic Medication and analgesic Medication medications for her pain months Date ago Date but they were not helpful. Head Diagnostic_procedure and Diagnostic_procedure neck Diagnostic_procedure examination Diagnostic_procedure , cranial Diagnostic_procedure nerve Diagnostic_procedure examination Diagnostic_procedure and vital Diagnostic_procedure signs Diagnostic_procedure were within Qualitative_concept normal Qualitative_concept limits Qualitative_concept .
Intraoral Diagnostic_procedure examination Diagnostic_procedure was completed using percussion Diagnostic_procedure testing Diagnostic_procedure , vitality Diagnostic_procedure testing Diagnostic_procedure and probing Diagnostic_procedure for evaluation of her mandibular Biological_structure posterior Biological_structure teeth Biological_structure in the region of the chief complaint.
Her left Biological_structure mandibular Biological_structure first Biological_structure molar Biological_structure was endodontically Therapeutic_procedure treated Therapeutic_procedure 3 Date years Date prior Date and tested Diagnostic_procedure non Lab_value - vital Lab_value , while her remaining mandibular Biological_structure teeth Biological_structure were normal Lab_value on vitality Diagnostic_procedure testing Diagnostic_procedure with evaluation Diagnostic_procedure of several Detailed_description opposing Detailed_description non Detailed_description - restored Detailed_description and non Sign_symptom - carious Sign_symptom teeth Biological_structure as internal controls.
Gingival Biological_structure tissues Biological_structure in both jaws Biological_structure were non Sign_symptom - inflamed Sign_symptom and there was no gross evidence of plaque Sign_symptom or calculus Sign_symptom .
Periodontal Sign_symptom pockets Sign_symptom in her mandible Biological_structure ranged from 4 Quantitative_concept to Quantitative_concept 6mm Quantitative_concept with no significant bony Sign_symptom defects Sign_symptom .
Full Biological_structure mouth Biological_structure dental Diagnostic_procedure X Diagnostic_procedure - rays Diagnostic_procedure and a panoramic Detailed_description radiograph Diagnostic_procedure were taken and showed relatively Detailed_description well Detailed_description - defined Detailed_description radiolucent Detailed_description lesions Sign_symptom in multiple Detailed_description regions Detailed_description of the mandible Biological_structure bilaterally Detailed_description , with a pseudocystic Detailed_description ( multilocular Detailed_description ) appearance; cone Detailed_description - beam Detailed_description computed Diagnostic_procedure tomography Diagnostic_procedure confirmed these findings and revealed a large Severity lytic Detailed_description lesion Sign_symptom of her left Biological_structure posterior Biological_structure mandible Biological_structure in the region of her chief complaint (Figure 1).Our clinical and radiographic differential diagnosis for her chief complaint included chronic Detailed_description apical Disease_disorder periodontitis Disease_disorder , radicular Disease_disorder cyst Disease_disorder , central Disease_disorder giant Disease_disorder cell Disease_disorder granuloma Disease_disorder , keratocystic Detailed_description odontogenic Disease_disorder tumor Disease_disorder , ameloblastoma Disease_disorder , odontogenic Disease_disorder fibroma Disease_disorder , neuralgia Sign_symptom / neuropathy Disease_disorder or mandibular Biological_structure involvement of Gaucher Disease_disorder disease Disease_disorder given her medical history.
Our findings were discussed Clinical_event with the patient and written consent was obtained for surgical biopsy Diagnostic_procedure of her left Biological_structure mandible Biological_structure with local Medication anesthesia Medication for more definitive diagnosis.
A four Detailed_description - corner Detailed_description gingival Therapeutic_procedure flap Therapeutic_procedure buccally Biological_structure was reflected in her posterior Biological_structure left Biological_structure mandible Biological_structure extending from the canine Biological_structure to the second Biological_structure molar Biological_structure , and cortical Biological_structure bone Biological_structure was removed Therapeutic_procedure with a surgical Therapeutic_procedure bur Therapeutic_procedure to create Therapeutic_procedure a Therapeutic_procedure window Therapeutic_procedure for access to the lesion Sign_symptom .
Pathologic Sign_symptom soft Biological_structure tissue Biological_structure was evident through the access window.
The entire pathologic Sign_symptom soft Biological_structure tissue Biological_structure along with the bone from the access window was submitted to the pathology Nonbiological_location laboratory Nonbiological_location for histological Diagnostic_procedure evaluation Diagnostic_procedure .
Histopathological Diagnostic_procedure findings Diagnostic_procedure revealed infiltration Sign_symptom of jawbone Biological_structure marrow Biological_structure with fibrous Detailed_description connective Detailed_description tissue Detailed_description containing abundant Gaucher Sign_symptom cells Sign_symptom (Figure 2).
There was no evidence of abscess Sign_symptom or neutrophils Sign_symptom , granuloma Disease_disorder or malignancy Sign_symptom .
Postoperative Diagnostic_procedure healing Diagnostic_procedure was uneventful Lab_value , and the patient reported resolution Outcome of her chief complaint and symptomatology at 1 Date - month Date follow Clinical_event - up Clinical_event .
She was referred Clinical_event to her physician Nonbiological_location for consultation Clinical_event and further evaluation Diagnostic_procedure as related to her Gaucher Disease_disorder disease Disease_disorder status following our findings.
She was again treated with ERT Medication and at 1 Date - year Date re Clinical_event - evaluation Clinical_event was still symptom Sign_symptom free in her oral Biological_structure cavity Biological_structure .