A 22-year-old male patient with a history of slow growing nontender hard swelling on left side of jaw since four months was referred to the outpatient clinic of Department of Oral and Maxillofacial Surgery. The patient didn't have any complaint of pain, but there was a history of occasional salty discharge in the mouth. There were no other medical complaints or family history of similar swelling.The patient was otherwise average built, with non-significant medical findings. Initial clinical examination revealed extra oral asymmetry due to oval-shaped swelling of size approximately 3cm X 2cm, on left side angle of mandible, with diffuse border. Antero-posteriorly swelling extends from left mandibular angle to left mandibular body region, super-inferiorly from the inferior border of the mandible to tragus [Table/ Fig-1]. Overlying skin was normal and non-adherent to deeper structures. No draining sinus was seen extra orally. No neurologic changes were present. Intraorally, on palpation bony hard non-tender swelling, was noted, in the third molar on lingual side and bony swelling with eggshell crackling on buccal aspect in the second molar region extending from the second molar to the retromolar region. Overlying mucosa was normal with a draining sinus in the region of the second molar.The second molar with slight mesial angulation and third molar with distal migration was noticed.On aspiration, straw colored creamy fluid was obtained with traces of pus in it and was further sent for cytologic examination.A panoramic image revealed the presence of round, well-defined cystic lesion extending from the root apex of the lower left second molar causing root resorption and extending up to third molar causing its distal migration. An additional radiolucent lesion which appeared to be an extension of the anterior lesion was separated by the third molar, extending into the ascending ramus up to the sigmoid notch. A Cone-Beam Computed Tomography Odontogenic Keratocyst (OKC) and Ameloblastomas are slow growing benign odontogenic lesions that primarily occur in the molar region of the mandible. Clinically and radiographically both ameloblastoma, especially the Unicystic ameloblastoma and OKC are indistinguishable due to the similar location of occurrence and the age of patients. It is very rare for these lesions to arise simultaneously in a patient's jaw. The co-occurrence of Ameloblastomas with odontogenic cysts or other odontogenic lesions (histologically in a single lesion)have already been described as combined or hybrid lesions. There are very few reported cases in the English literature for simultaneous occurrence of Unicystic Ameloblastoma and OKC as completely distinct lesions. Here we present such a rare case of the simultaneous occurrence of OKC and ameloblastoma in the posterior region of the mandible of a 22-year-old male in close relation.[table /Fig-1a Resorption of roots of the second molar was seen with the downward shifting of the inferior alveolar canal with intact inferior border.
We could reach a conclusion and recommend that patients on long-term low-dose aspirin (75-150 mg) need not to discontinue their aspirin dose prior to routine exodontia and can be carried out safely with enhanced local hemostatic measures, if required.
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