Medical Analysis Report

I. Imaging Findings

1. X-ray panoramic film shows a marked expansile lesion of the right mandible, presenting with “cystic” or “soap bubble” radiolucent regions. Some areas appear “honeycomb-like” or multilocular, with accompanying osseous expansion.
2. CT scan reveals an outwardly expansile, relatively well-defined cystic lesion containing multiple bony septations (trabeculations). The cortical bone is thinned and may even show signs of perforation.
3. MRI demonstrates an irregular cystic-solid signal within the lesion with obvious multilocular septations. On T2WI, fluid-fluid levels are noted, which indicates the presence of different components or stratified fluid within the lesion. Continuity of the right mandibular bone is affected, but no distinct fracture line is visualized. Surrounding soft tissue is significantly deformed by compression, but there is no evidence of large-scale infiltration.

II. Possible Diagnoses

Considering the patient’s age, clinical presentation, and imaging characteristics, possible diagnoses or differential diagnoses include:

1. Aneurysmal Bone Cyst (ABC): Commonly occurs in children and adolescents; typically shows multilocular bone destruction on imaging, with fluid-fluid levels on MRI and notable expansile changes.
2. Vascular Malformation: Can also present with expansile bony changes; however, imaging often demonstrates vascular flow voids or enhancement, and distinct septations might not be as apparent.
3. Central Giant Cell Granuloma: May exhibit a multilocular “soap-bubble” appearance, but usually lacks the distinct fluid-fluid levels seen in ABC.
4. Benign Odontogenic Tumors (e.g., Ameloblastoma, Odontogenic Keratocyst): Can show bone destruction and expansion, potentially multilocular or honeycomb-like on imaging; fluid-fluid levels are not commonly seen.
5. Telangiectatic Osteosarcoma or Vascular Bone Tumor: Rare in clinical practice, and can mimic aneurysmal bone cyst on imaging. Histopathological examination is necessary to confirm and rule out malignancy.

III. Final Diagnosis

Taking into account the patient’s age of 7 years, an 18-month history of repeated swelling and remission, and imaging features (expansile destruction, multiple compartments, and fluid-fluid levels), the most likely diagnosis is: Aneurysmal Bone Cyst (ABC).

Since there is some radiologic overlap with vascular bone tumors, the final diagnosis should be confirmed with pathological examination to exclude malignant lesions (for instance, using electron microscopy or histological assessment to rule out vascular sarcoma or osteosarcoma components).

IV. Treatment Plan and Rehabilitation

1. Treatment Strategies

1. Surgical Management: Standard approaches include curettage or curettage followed by bone grafting. In cases of larger or recurrent lesions, partial resection may be considered, and reconstruction with autografts or allografts may be performed. If vascular supply is abundant, a tourniquet or vascular embolization can be used intraoperatively to reduce bleeding.
2. Endovascular Therapy: For patients in whom immediate surgery is not feasible or with high-risk lesions, selective arterial embolization may be performed to reduce blood supply to the lesion, facilitating subsequent intervention or symptomatic relief.
3. Adjunctive Measures: Depending on the patient’s condition, repeated sclerotherapy injections may be evaluated as an additional intervention.

2. Rehabilitation / Exercise Prescription

During treatment for a mandibular lesion, attention should be given to the patient’s diet, mastication, and oral functional training, while also considering overall health. An exercise plan can be designed following the “FITT-VP” principles (Frequency, Intensity, Time, Type, Progression, and Individualization):

• Frequency: After surgery or when the condition is stable, schedule low-intensity aerobic exercise 2-3 times per week (e.g., light walking, low-intensity swimming). For oral functional training, practise mild mouth-opening and closing exercises 2-3 times a day, 5-10 minutes per session.
• Intensity: Avoid pain or fatigue. Early mandibular function training should involve gentle movement, avoiding wide mouth-opening or chewing hard foods.
• Time: Recommend 20-30 minutes per session for low-intensity aerobic exercise. For oral function, 5-10 minutes per session is sufficient at the initial stage.
• Type: Choose activities that create minimal impact on joints and bones, and include appropriate mouth-opening exercises (e.g., slow chewing of soft foods, gentle jaw-opening drills).
• Progression and Individualization: Gradually increase exercise duration and intensity based on the patient’s postoperative or clinical recovery. If feasible, progressively introduce more challenging oral functional exercises. Continuously monitor local bone status and the patient’s overall tolerance.

V. Disclaimer

This report is based solely on the provided information and serves as a reference for healthcare professionals or patients. It cannot replace in-person consultations or professional medical advice. The specific treatment plan must integrate the patient’s actual condition, additional imaging studies, and laboratory test results, and be determined by an experienced clinician following a comprehensive assessment.