I remembered to get some good images, so I thought I would share this pathology case and see if anybody can guess the biopsy report.

This 70 y/o gentleman reports that about five years ago he slipped in his bathroom, fell and struck his head. He had a forehead laceration and loss of consciousness, and was admitted to a hospital where he woke up and had his laceration repaired and he was monitored for a few days. A CT of the head and neck showed no intracranial injury, no skull fracture, or any maxillofacial fractures. There was, however, an incidental 5 mm radiolucency in the right mandible. He was told at that time that it would be okay to monitor this.

Since then, several dentists and physicians all recommend monitoring this. However, at this point he has noticed enlargement of the right anterior mandible and lingual displacement of his premolars. He had no pain, paresthesia, tooth mobility or lymphadenopathy. He has COPD, CAD, and GERD. He takes Xarelto, metoprolol, and an inhaler.

Here are some photos, a Panorex, and a couple screen shots of his CT:

[image:Chin.jpg][image:Screenshot 2021-03-09 163136.jpg][image:Panorex.jpg]

[image:Axial.jpg][image:Coronal_1.jpg][image:Coronal 2.jpg]

After administering local anesthetic, I aspirated a milky fluid. I then made a 2 cm horizontal mucosal incision to expose the cystic epithelium. I then excised a 1x1 cm square and placed it in a formalin container for the pathologist. I irrigated out the cystic cavity to remove debris, and noted a well-visualized epithelial lining around the entire cavity. Hemostasis was good, so I re-approximated the mucosa was several 3-0 chromic gut sutures.

[image:Aspirate small.jpg][image:Open_wound_small.jpg][image:Specimen small.jpg][image:closure small.jpg]

I will post the results of the biopsy in a couple days. I’m looking forward to hearing your votes.