AB188. SOH24AB_087. A sagittal split osteotomy (SSO) approach for removal of a large cementoblastoma at the mandibular angle: a case report

Background: A cementoblastoma is a rare, benign odontogenic tumour arising from ectomesenchymal cells, and the subsequent disorganised proliferation of cementoblasts results in deposition of cement-like tissue around the roots of teeth. Benign lesions at the angle of the mandible are frequently removed by a conventional intra-oral approach to gain access and achieve complete visualization. This method is quick and effective when dealing with small, benign lesions that are superficially located at the angle of the mandible. However, the removal of large and deeply located lesions with a conventional intraoral approach brings about a unique set of challenges including: lack of complete visualization of the lesion; difficulty in identification and protection of the inferior alveolar nerve, and the necessity of removing a considerable amount of osseous structure, thus increasing the risk of a mandibular fracture. Alternative techniques for such lesions include an extra-oral approach, but this could potentially create a cosmetic defect from cutaneous scarring and can result in facial nerve injury.

Case Description: We describe a case in which a right-sided sagittal split osteotomy was performed under general anaesthesia. This technique provided adequate surgical access to and visualization of the lesion, as well as preserving the buccal and lingual cortices, maintaining osseous integrity and allowing better aesthetic outcome. The technique of sagittal split osteotomy allows optimal access to the tumour with complete visualization, identification and protection of the inferior alveolar nerve, and with minimal bone removal, while maintaining mandibular integrity, strength and facial aesthetics.

Conclusions: The case report demonstrated the effectiveness of sagittal split osteotomy in the removal of a unilateral mandibular cementoblastoma.

Keywords: Benign odontogenic tumor; cementoblastoma; mandibular angle; sagittal split osteotomy; true cementoma