Primary hyperparathyroidism presenting as a brown tumor in the mandible: a case report

BACKGROUND

Primary hyperparathyroidism is characterized by hypercalcemia and elevated or inappropriately normal serum levels of parathyroid hormone. Brown tumor of bone is a rare non-neoplastic lesion resulted from abnormal bone metabolism in hyperparathyroidism. However, nowadays, skeletal disease caused by primary hyperparathyroidism is uncommon. We report a case of brown tumor in the mandible as the initial exhibition of primary hyperparathyroidism associated with an atypical parathyroid adenoma.

CASE PRESENTATION

The patient was a 49-year-old female, she had a pain mass on the right mandible a year ago and was treated with root canal therapy and marginal resection. After seven months, the mass recurred and enlarged. Enhanced CT scan, laboratory examination, Ultrasonography, ^99mTc-MIBI SPECT-CT scintiscan and pathological examination were used to confirm the diagnosis of brown tumor. The patient's symptom improved after parathyroidectomy.

CONCLUSIONS

^99mTc-MIBI SPECT/CT scintigraphy is a highly sensitive examination of the localization diagnosis of hyperparathyroidism. Brown tumors should be considered in the differential diagnosis of osteolytic lesions to avoid unnecessary and harmful interventions.

Gossypiboma mimicking recurrent mandibular tumor: case report

Gossypiboma is not a commonly known surgical complication. It is a tumorous lesion usually caused by hemostatic material used in surgery. Such lesions are most commonly described after abdominal surgery. In this case report, the authors describe a case of a 17 year old female patient, operated for a mandible tumor. Histopathologically it was an ameloblastoma. The patient was treated lege artis, with the use of Surgicel® felt (Surgicel FibrillarTM Absorbable Hemostat). After two months, the young woman returned to clinics with a tumorous lesion at the same location. On the CT scan the lesion appeared to be a recurrence of the originally diagnosed ameloblastoma. Histopathologically, the lesion consisted of a foreign material with surrounding granulation tissue and massive inflamation. The foreign material had an atypical structure. Subsequent consultations and consensus at the clinic confirmed that it was a haemostatic foreign material with a surrounding hyper-inflammatory response mimicking a tumor, known in the literature under various names, most often as gossypiboma or textiloma.

Implant-assisted removable prosthetic rehabilitation after distraction osteogenesis in a patient with ameloblastoma recurrence: A case report

INTRODUCTION

A resected mandibular edentulous ridge resulting from an ameloblastoma and marginal mandibulectomy is a restorative challenge. To maintain oral hygiene, recurrent examinations, and for long-term maintenance, a removable dental prosthesis is preferred to an implant-supported fixed dental prosthesis.

PATIENT CONCERNS

A 28-year-old Asian man was referred for evaluation of a radiolucent area on the right side of the mandible. The right mandibular area had increasingly enlarged over a period of ≥5 months. Marginal resection and inferior alveolar nerve repositioning of the mandible were performed by oral surgeons, followed by reconstruction of the resected mandible with distraction osteogenesis. After 6 years, the patient presented with swelling of the same area.

DIAGNOSIS

Histopathological examination revealed recurrence of benign ameloblastoma in the mandible. After mass excision of the recurrent benign tumor, dental implants were installed. To aid with recurrent examinations and oral hygiene maintenance, a treatment plan using implant-assisted removable dental prosthesis, instead of a fixed prosthesis, was formulated.

INTERVENTIONS

The edentulous area was rehabilitated with a tooth- and implant-assisted removable partial denture. Due to the insufficient intermaxillary clearance, the removable prosthesis was designed in such a manner that retention, support, and stability could be ensured by separate components.

OUTCOMES

The tooth- and implant-assisted removable partial denture showed satisfactory function and esthetics. No complications were observed in the dental prosthesis and supporting tissues during the 3-year follow-up period.

CONCLUSION

In recurrent ameloblastoma cases, a removable dental prosthesis may be an effective treatment option for oral rehabilitation. The type of denture design used in this study is novel for implant-assisted removable partial denture rehabilitation.

Rare brown tumour of the mandible secondary to tertiary hyperparathyroidism in a renal transplant recipient

Brown tumours are rare osteolytic lesions that occur secondary to hyperparathyroidism (HPT). In 2% of all cases, the craniofacial bones are affected, most frequently the mandible. HPT is classified according to aetiology into three types, of which tertiary HPT is the rarest. Here we present the case of a 42-year-old man who had received a renal transplant 16 years previously and was referred due to swelling on the right side of his jaw. An orthopantomogram revealed a multilocular radiolucency in the right body of the mandible. The bony lesion was treated by surgical enucleation. After histopathological examination of the lesion, the diagnosis of brown tumour of the mandible secondary to tertiary HPT was reached. The patient's recovery was uneventful and follow-up radiography showed good bone healing.

Mandibular reconstruction with autogenous non-vascularised bone graft

Background

Reconstruction of mandibular defects can be challenging because an acceptable aesthetic and functional outcome must be achieved simultaneously.

Aim

To evaluate the pattern of mandibulectomy and reconstruction materials used in the reconstruction of mandibular defects.

Materials and methods

This was a retrospective study of mandibulectomies with reconstruction in Sokoto, Nigeria between 2012 and 2016. Data such as demographics, type of tumour, type of resection and type of reconstruction materials used were extracted and stored.

Results

Fifty-two cases of mandibulectomies were done comprising 24 males and 28 females (ratio 1:1.2). Age ranged 5–80 years with mean±SD (37.8±15). Most of the cases 30 (57.7%) were on the right. There are 35 (67.3%) benign and 17 (32.7%) malignant cases. Thirty (57.7%) lateral, 16 (30.8%) condylar, 1 (1.9%) central and 5 (9.6%) combined mandibular defects were seen. Reconstruction plate alone was used in 11 (21.2%) cases, reconstruction plate with rib and tibia grafts in 16 (30.8%) cases, reconstruction plate with Iliac crest and tibia grafts in 15 (28.8%) cases. Graft length ranged from 0–20cm. There was satisfactory outcome altogether in 32 (80.0%).

Conclusion

This study has shown the types of mandibulectomies and reconstruction materials used in our centre.

Prognosis of osteosarcomas in the mandible: 15-year experience of 55 patients

Our goal was to evaluate the prognosis of osteosarcomas (OS) in the mandible for finding out the best treatment.Patients diagnosed with OS in the mandible from January 2000 to December 2015 were retrospectively enrolled. Demographic, tumor-specific, treatment, and survival data were collected and analyzed.A total of 55 patients (35 male and 20 female) were included, all patients had first manifestation of swelling. Cachexia occurred in 15 (27.3%) patients. Chondroblastic type was the most common histology subtype followed by osteoblastic type. High grade tumors were found in 30 (63.6%) patients. 33 (60%) patients received an operation of hemimandibulectomy, and free fibula reconstruction was performed in 20 (36.4%) patients. The 5-year recurrence-free survival (RFS) and disease-specific survival (DSS) rates were 73.6% and 66.9%, respectively. Univariate prognostic analysis reported risk factors of tumor grade, reconstruction type (free fibula flap vs non-free flap), and operation extent were significant for the recurrence, and reconstruction type and operation extent were significant for the disease-specific death, but in multivariate analysis, only the factor of operation extent was significantly associated with both the recurrence and death.A wide excision extent such as hemimandibulectomy is suggested for OS in the mandible for achieving good prognosis.

Is conservative surgery a better choice for the solid/multicystic ameloblastoma than radical surgery regarding recurrence? A systematic review

PURPOSE

Determine if conservative surgery of primary solid/multicystic ameloblastoma (SMA) is capable of decreasing the recurrence rate as effectively as radical surgery.

METHODS

We searched in MEDLINE, Web of Science, Scopus and Cochrane Library for original studies reporting on the conservative or radical treatment of primary SMA and the related recurrence rate. All selected data were independently assessed. Meta-analysis was performed and the Relative Risk (RR) of recurrence with a confidence interval of 95% was the effect measure. P value for the summary effect of < 0.05 was considered statistically significant.

RESULTS

The 2647 records retrieved were reduced to 7 studies to be qualitatively assessed and 4 studies were included in the meta-analysis. RR of 1.88 [0.59, 5.95] of the pooled values pointed that recurrence rate after the conservative surgery is neither comparable nor lower than the radical surgery (P = 0.28).

CONCLUSIONS

Conservative surgery does not reduce the recurrence rate as efficiently as radical surgery for primary SMA. However, there is not enough evidence to support this statement.

An unusual case of intraosseous mucoepidermoid carcinoma of the mandible: A case report and literature review

RATIONALE

Mucoepidermoid carcinoma (MEC) is the most common primary salivary gland malignancy. Ectopic MEC can occur in any part of the body, however, only 2% to 4% of MEC could be detected in the jaw, which is named intraosseous mucoepidermoid carcinoma (IMC). IMC is usually a low-grade carcinoma. Uni- or multilocular radiographic lesions should be differential diagnosed with ameloblastoma, odontogenic cysts, and glandular odontogenic cyst (GOC). Radical surgery may prefer for a favorable prognosis. Whereas IMC can recur long after the operation, a long-term follow-up system should be implemented. Owing to its rarity and controversial issues, we report a case report and review the literature to discuss its clinical features, treatments, radiological, and histological characteristics.

PATIENT CONCERNS

The patient presented with a 2-month history of mild pain in the lower left posterior jaw without history of surgery or trauma to the mandible.

DIAGNOSES

Routine postoperative pathology showed that the mass was consistent with a mandibular mucoepidermoid carcinoma.

INTERVENTION

Radical surgery and digital mandibular reconstruction were performed.

OUTCOME

Postoperative imaging showed that the height of the mandible and the symmetry of the mandible were satisfactory. The patient was also satisfied with her appearance. Follow-up has been established.

LESSONS

Effective surgical treatment allows patients to have a favorable prognosis. A long-term follow-up system should be practiced, because local recurrences and regional metastasis could happen even after decades.

The glomus tumor resorbed bone and teeth in the mandible: a case report

BACKGROUND

A glomus tumor is a rare neoplasm usually found in the dermis or subcutaneous tissue of the extremities. It is rare for the glomus tumor to occur on the head and face. Only 26 glomus tumors of the oral region and affected bone have been reported in the English-language literature (Table 1). We report a case of a glomus tumor at the mandible. As a new point, the glomus tumor resorbed a bone and teeth roots when the tumor progressed into the mandible.

CASE PRESENTATION

The patient was a 44-year-old Japanese man who complained swelling of the right mandible. Radiographic examination showed a multilocular radiolucency area in the left mandible. Radiographic findings on our case resembled those of a common benign tumor. The lesion occupied to the premolar and molar area and revealed that the tumor resorbed the roots of the teeth. The lesion was removed surgically with the buccal cortical bone and buccal mucosa in contact with the mass of the tumor. The mass fully excised intraorally under general anesthesia, and the inferior alveolar nerve in contact with the mass was preserved. The specimen was pathologically diagnosed as a glomus tumor. Immunohistochemical staining was positive for vimentin, muscle-specific actin/HHF35, and calponin. A hairline-shaped area of positive staining for type IV collagen surrounding the tumor cells was also observed. In contrast, staining for alpha-SMA, cytokeratin (AE1/AE3), cytokeratin (CAM5.2), CK19, CD31, CD34, CD68, p63, S-100, Factor VIII, and desmin was all negative. The Ki-67 labeling index was almost 1%. A recurrent tumor was again detected in the site below the primary tumor at an 8-year follow-up, and it was surgically removed. The patient has had no symptoms of recurrence in 2 years after the second operation.

CONCLUSION

The glomus tumor resorbed a bone and teeth roots when the tumor progressed into the mandible. The immunohistochemical features of the tumor were consistent with those described in previous reports. It is important to completely remove the Glomus tumor.

Ameloblastic Fibro-Odontoma

The ameloblastic fibro-odontoma (AFO) is a rare, mixed odontogenic tumor exhibiting the histological characters of the ameloblastic fibroma and complex odontoma. It is comprised of proliferating ectodermal and mesenchymal components of odontogenic tissue as well as enamel and dentin. AFO normally presents as an asymptomatic swelling of the posterior maxilla or mandible and is usually associated with developing teeth, occurring predominantly in children and adolescents. Such lesions are generally found upon radiographic examination of patients whose tooth eruption is delayed. This lesion often includes an unerupted permanent tooth, and extraction of this tooth is a common treatment. The purpose of this report is to describe an AFO in the posterior mandible of a nine-year-old girl for whom enucleation was performed under general anesthesia without extracting the displaced permanent mandibular left second molar. Two years later, the tooth erupted into occlusion without tumor recurrence.

Adjuvant conundrum in central mucoepidermoid carcinoma of the mandible: case presentation and literature review

The cornerstone modality of treatment of central mucoepidermoid carcinoma (CMEC) of the mandible is surgery, optimally, an en bloc resection with/without segmental or hemimandibulectomy. Notwithstanding the documentation of a survival benefit in few case reports with the addition of postoperative radiotherapy in carefully selected high-risk patients, there does not exist a clearly defined consensus regarding the role of adjuvant radiotherapy. We report the case of a 49-year-old man who presented with right lower jaw swelling which on imaging was found to be a multiloculated lesion causing bony expansion and cortical destruction of the mandible and was diagnosed with CMEC after radiological and histopathological criteria were met. He underwent right hemimandibulectomy and histopathology showed squamous and mucinous cells with positive mucicarmine staining and characteristic immunohistochemistry markers confirming the diagnosis of CMEC. He subsequently underwent adjuvant radiotherapy and is disease free 5 years since treatment completion.

Full-Mouth Rehabilitation with Bone-Level Implant Guide and Monolithic Zirconia Prosthesis for Fibular Free Flap Reconstruction: A Case History Report

The fibular free flap (FFF) approach is the preferred option for reconstruction of segmental mandibular deficiencies. Fixed dental prostheses are recommended for patients who have undergone FFF jaw surgery to improve quality of life, but treatment of these patients with an implant-supported prosthesis is challenging because of the thin bone and thick soft tissue in the fibula. This case history reports the use of a bone-level implant guide fabricated with a computer-aided system and milled customized long abutments for implant placement and prosthodontic procedures. Advanced digital technologies can facilitate jaw rehabilitation in patients with bone flap.

Accuracy of computer-assisted surgery in mandibular reconstruction: A systematic review

Computer-assisted surgery (CAS) for mandibular reconstruction was developed to improve conventional treatment methods. In the past years, many different software programs have entered the market, offering numerous approaches for preoperative planning and postoperative evaluation of the CAS process of mandibular reconstruction. In this systematic review, we reviewed planning and evaluation methods in studies that quantitatively assessed accuracy of mandibular reconstruction performed with CAS. We included 42 studies describing 413 mandibular reconstructions planned and evaluated using CAS. The commonest software was Proplan/Surgicase CMF (55%). In most cases, the postoperative virtual 3-dimensional model was compared to the preoperative 3-dimensional model, revised to the virtual plan (64%). The commonest landmark for accuracy measurements was the condyle (54%). Accuracy deviations ranged between 0 mm and 12.5 mm and between 0.9° and 17.5°. Because of a lack of uniformity in planning (e.g., image acquisition, mandibular resection size) and evaluation methodologies, the ability to compare postoperative outcomes was limited; meta-analysis was not performed. A practical and simple guideline for standardizing planning and evaluation methods needs to be considered to allow valid comparisons of postoperative results and facilitate meta-analysis in the future.

Large ossifying fibroma of jaw bone: a rare case report

Ossifying fibroma (OF) is classified as, and behaves like, a benign bone neoplasm. It is often considered to be a type of fibro-osseous lesion (FOL). It can affect both mandible and the maxilla, particularly the mandible. This bone tumour consists of highly cellular, fibrous tissue that contains varied amounts of bone or cementum resembling calcified tissue. Present case is an unusual report of central ossifying fibroma involving the left side of mandible in an 18 year old female patient, who presented to the department with a painless hard swelling. The lesion was treated by surgical resection and reconstruction.

Malignant external otitis following radiotherapy for oral cancer: A case report

RATIONALE

Although an ototoxicity is well-known as adverse event of the radiotherapy, it is not widely known that immunosuppressed patients who underwent radiotherapy in head and neck region have risk of malignant external otitis.

PATIENT CONCERNS

A 68-year-old man with diabetes, who had been diagnosed as intraosseous squamous cell carcinoma of the right mandible, underwent surgical resection. He received a total of 60 Gy/30Fr postoperative radiation. Four months after the course of radiation, he suffered from right aural fullness, otalgia and otorrhea.

DIAGNOSES

Clinical examination revealed granulation and existence of Pseudomonas aeruginosa in the external auditory canal. Computed tomography showed expansive inflammation and erosion in the temporal bone. The patient is elderly and diabetes. These findings led to the diagnosis of malignant external otitis.

INTERVENTIONS

The ear irrigation and administration of quinolones were started. Afterwards, fistula was formed in the oral cavity, and connected to the right external auditory canal. Therefore, irrigations were performed not only from ear but also from the oral fistula.

OUTCOMES

Eight weeks after starting treatment, the malignant external otitis was completely healed.

LESSONS

Physicians should raise awareness of malignant external otitis in immunosuppressed patients with oral cancer after radiotherapy.

Extrapleural Pneumonectomy for Sarcomas Report of two Cases

Aims and background

Extrapleural pneumonectomy (EPP), which is a very uncommon surgical procedure, is electively indicated only in patients with early stages of malignant pleural mesothelioma, a rare condition. Two adults suffering from sarcomas and treated with EPP are described here.

Methods

A 29-year-old male with four left-sided lung metastases and ipsilateral pleural effusion from a chondrosarcoma of the mandibula and a 64-year old woman with a megamass in the left chest due to a local recurrence of a hemangiopericytoma underwent EPP.

Results

Extra-EPP-field multiorgan progression was diagnosed 14 months following surgery in the first patient who died at the 24th postoperative month but remained free of disease at the site of surgery. The second patient had a chest wall relapse at the forty-third month following EPP, which was treated by partial resection of the second and third ribs. She is alive and disease-free at the twelfth postoperative month.

Discussion

EPP may be considered for salvage treatment in selected patients with intrathoracic sarcomas not amenable to other effective therapies to achieve mid- to long-term disease control, even in the case of advanced spread.

Abdominal and Extra-Abdominal Desmoid Tumors. Report of 21 Cases

Desmoid tumors are easily diagnosed when located within the muscles of the abdominal wall. On the contrary, extra-abdominal desmoids, because of their various sites and lack of pathognomonic signs, can be very difficult to diagnose. A review of 21 cases of the Istituto Nazionale Tumori of Milan confirms that these tumors primarily affect young, multiparous women and that even extra-abdominal desmoids are prevalent in women. All patients were treated by radical surgery consisting of wide excision in 18 cases, hemimandibulectomy in 1 case, and amputation of the lower limb in 2 cases. Radical surgery resulted in no recurrences in all cases but one. Our results are in contrast with the relatively high recurrence rates reported in the literature.

Occlusal adjustment after local resection of type 1 condylar osteochondroma

To evaluate the feasibility of the orthodontic traction after local resection of the condylar osteochondroma (OC).From November 2011 to September 2016, consecutive patients with condylar OC who underwent orthodontic extraction after local resection of the mass were reviewed. Clinical data and cone-beam computed tomography (CT) were obtained before treatment (T0), 1 week after surgery (T1), and at least 6-month follow-up after OC resection (T2). Repeated-measures analysis of variance with Bonferroni multiple-comparison test was used to compare the 3-dimensional cephalometric variables at different time points and the paired t test was used to compare changes of temporomandibular joint (TMJ) space between the 2 sides at T1 and T2.The sample consisted of 23 patients (16 females and 7 males). The mean postoperative follow-up interval was 10.9 months. No recurrence was observed during the postoperative follow-up period. Facial symmetry and occlusion were greatly improved. B deviation and the distance of gonion on the OC-affected side to the Frankfort horizontal (FH) were significantly improved from T0 to T1 and T2 (P < .01). The anterior space (AS) and superior space (SS) of the OC-affected side were significantly larger than that of the contralateral side at T1 in parasagittal CT views (P < .05), while no difference was found between the two sides at T2.Local resection is an effective technique with less damage to the condyle. The application of postoperative directional traction could guide the condyle into the fossa, achieve normal TMJ space and stable occlusion, and eventually provide functional and esthetic outcomes.

Expression of TP53 and IL-1α in unicystic ameloblastoma predicts the efficacy of marsupialization treatment

In this study, we evaluated the effects of marsupialization in treating unicystic ameloblastoma (UA) and investigated the relationship between TP53 and interleukin 1 α (IL-1α) expression and the clinical outcome of UA treated with marsupialization.Consecutive patients treated with marsupialization and curettage at Shanghai Ninth People's Hospital were included. According to the unified standard, 48 patients were included in this study. Of these, 20 showed a good response, 10 a partial response, and 18 no response, based on the outcome of the marsupialization procedure. The expression of proteins TP53 and IL-1α was detected with immunohistochemistry (IHC). The clinical and pathological characteristics of the patients were analyzed.Analysis of the clinical and pathological characteristics showed that the effects of marsupialization treatment were significantly associated with lesion location (P < .001) and tumor diameter (P = .01). IHC showed that TP53 expression was significantly higher in the good-response group than in the partial- or no-response group (P = .02), and IL-1α expression was significantly higher in the good-response group than in the partial- and no-response groups (P = .03).Marsupialization is an effective preliminary procedure for treating UA before curettage and peripheral ostectomy. The expression of the TP53 and IL-1α proteins correlates directly with the outcome of UA treated with marsupialization.

Management strategy in patient with familial gigantiform cementoma: A case report and analysis of the literature

RATIONALE

Familial gigantiform cementoma (FGC) is a rare benign autosomal dominant fibrocemento-osseous lesion generally limited to the facial bones, typically in the anterior portion of the mandible; it is often associated with abnormalities of the long bones and prepubertal pathologic fractures. Owing to the small number of such patients, a uniform treatment criterion has not been established. This paper presents a patient with FGC who was treated in our department, and offers a systematic review of the patients reported in the literature. Our aim was to explore the treatment strategy for patients with FGC.

PATIENT CONCERNS

Our patient, a 13-year-old boy, presented with a painless enlargement of the mandible first noted 2 years earlier. It had grown rapidly over the preceding 8 months, affecting both his appearance and ability to chew.

DIAGNOSIS

Based on the pathologic, clinical, and radiographic features, FGC was diagnosed.

INTERVENTIONS

Mandibuloectomy was performed. The mandibular defect was immediately reconstructed with his right vascularized iliac crest flap. At the same time, a PubMed search was conducted to identify studies reporting on other patients with FGC.

OUTCOMES

A 3-dimensional computed tomography (3D-CT) scan demonstrated appropriate height of the new alveolar bone. Follow-up results showed recovery of the patient's appearance and mandibular function. He was free of recurrence at 4-year follow-up.

LESSONS

FGC is a rare benign fibrocemento-osseous lesion of the jaws that can cause severe facial deformity. Incomplete removal leads to more rapid growth of the residual lesion. Therefore, extensive resection is a suitable strategy to avoid recurrence. Defects of the facial bones found intraoperatively should be repaired with resort to an appropriate donor site. However, it is important to be aware that patients with FGC always have concomitant abnormalities of skeletal metabolism and structure, as well as a vulnerability to fractures of the long bones of the lower extremity. Therefore, the optimal management strategy should include a review of treatment options for other patients as reported in the literature. An optimal protocol can not only provide sufficient high-quality bone suitable for the reconstruction of bone defects, but also minimize complications and maximize quality of life.

Metachronous ameloblastic fibro-odontoma and dentigerous cyst in the posterior mandible

An ameloblastic fibro-odontoma (AFO) is a rare mixed odontogenic tumor with histologic features of an ameloblastic fibroma in conjunction with the presence of dentin and enamel. It usually appears as a well-circumscribed radiolucency with radiopaque foci and slow growth and is commonly seen in children and young adults. A 13-year-old boy presented with an asymptomatic swelling in the posterior right region of the mandible and the right ascending ramus. The clinical, imaging, and histopathologic findings confirmed the diagnosis of an AFO. After 8 months, a radiolucent lesion involving the unerupted mandibular left third molar was observed; a final diagnosis of a dentigerous cyst (DC) was established for this lesion. Although coincidental events, metachronous odontogenic lesions suggest a possible common genetic origin, since both can be caused by related cellular signaling pathways. Complete enucleation is recommended for both AFOs and DCs; rates of recurrence are low.

Treatment Options for Amelobastic Carcinoma of the Mandible: A Case Series and Review of the Literature

We retrospectively review the only three cases in the Irish National Maxillofacial Unit over a 12-year period. Methods involved retrospectively reviewing clinical notes, radiology and histopathology of three cases. Case one was an 80-year-old male presenting with mandibular swelling, who received radiotherapy alone. Case two was a 26-year-old male with swelling and odynophagia. He underwent left hemimandibulectomy and fibular free flap reconstruction. Case three was a 64-year-old female with mental nerve involvement who underwent a right hemimandibulectomy. The cases presented here illustrate a diverse sample regarding patient demographics and management approaches. Surgery usually necessitates en bloc resection, free flap reconstruction and 1-1.5 cm margins. Adjuvant radiotherapy may be required for close margins.