Keywords:
Mandible; granuloma; foreign body; radiography, panoramic; osteolysis;
tomography, X‐ray computed.
A 7-year-old patient, in good general condition, consulted for a painful
right lower genian mandibular tumefaction persisting for more than a
month with inflamed skin. On palpation, the swelling was indurated and
difficult to mobilize in deep planes. The patient had multiple mobile
cervical adenopathies in the jugulocarotid and spinal chains.
Intraoral examination revealed an ill-defined vestibular redness facing
the erupting right mandibular first molar (46), which was painful to
percussion. On probing, it showed a distal pocket of 8 millimeters in
depth.
Panoramic radiograph (Figure 1A) was featureless. CT scan revealed a
well-limited hypodense image without a condensation line, facing the
vestibular side of the (46) and destroying the vestibular table from the
outset with an appearance of osteolysis of cancellous bone all around
(Figure 1C, D, E). Plurilamellar periosteal reaction was also noted
(Figure 1B). Narrow window sections (Figure 1F, G) revealed thickening
of the masseter muscle and partially of the buccinator. Radioclinical
confrontations were then in favor of a potentially aggressive lesion.
Biopsy confirmed the diagnosis of a vegetable foreign body inflammatory
granuloma (Figure 1H). The treatment was the removal of the skin lesion
with bone cavity curettage. The evolution was favorable.
The current case represents an uncommon oral disorder, known as
foreign-body reaction, resulting from the implantation of food vegetable
particles. This rare clinical entity has received several nomenclatures,
of which hyaline ring granuloma is the most current. According to the
literature, it occurs in several areas, including the lung,
gastrointestinal tract, and oral cavity. Women are less affected than
men, with the highest incidence in adults. The mandible is more affected
than the maxilla. This pathology is mostly reported in edentulous
patients using prosthesis, and it is associated with odontogenic cyst
walls, extraction sockets, deep periodontal pockets, and partially
erupted teeth as in the present case 1. It was an
unusual oral osseous lesion in a child, with clinical and radiographic
features possibly leading to misdiagnosis and inadequate treatment,
including an excessively aggressive approach2. Once
aware of this disorder, clinicians may prevent it, provide the proper
diagnosis, and indicate the appropriate treatment.
Conflict of interest: The authors declare that they have no
conflicts of interest.
Funding : This research did not receive any specific grant from
funding agencies in the public, commercial, or not-for-profit sectors.
A consent statement: A written informed consent was obtained in
accordance with the journal’s patient consent policy.
Data availability statement: The data that support the findings
of this study are available from the corresponding author upon
reasonable request.
Authors’ contribution: Dr. R. K. contributed to the study
design, radiographs’ analysis, and writing of the paper. Dr. I. CH. and
Dr. R. Z. contributed to the study design and radiographs’ analysis. Dr.
B.S. participated in the realization and interpretation of the
histological sections. Dr. T. BA. supervised the study, contributed to
radiographs’ analysis, and to the writing of the paper.