23 years old male chronic smoker working as heavy motor vehicle driver developed sudden onset of painful swelling in right cheek with rapid spread to submandibular and sublingual space with airway compromise.
Radiographically ( CT scan with contrast ) showed a lytic lesion in the body of mandible around uninterrupted second and third molar teeth extending inferiorly into submandibular and sublingual space.
- Preliminary tracheostomy done.
- Transcervical incision made 2 cm below the inferior border of mandible.
- After layered dissection inferior border of mandible identified.
- A large mass with well defined sac found arising from within the body of mandible.
- Incision and drainage done, 50ml of cheesy material let out.
- Thickened wall of the mass is completely exenterated and further cleared by drilling of the mandible.
- An innovative approach by obliterating the empty space by bioglass done. This is done to avoid biografting with materials like fascia lata in the unknown pathological entity.
- Bioglass obliteration helps to combat infection by its antibacterial property and this is by virtue of its alkaline pH.
- HPE showed features of epidermoid cyst ( Infected Odontogenic keratocyst)
- As we hoped lesion healed without complications and patient went back to his work!