This orthopantomogram (panoramic X-ray) of the human mandible reveals a significant diagnostic finding in the right mandibular body extending toward the symphysis. The image displays a large, well-defined multilocular radiolucent lesion characterized by two distinct internal architectural patterns: a 'honeycomb' appearance, consisting of numerous small, uniform radiolucent compartments separated by thin radiopaque septa, and a 'soap bubble' pattern featuring larger, more irregular circular radiolucencies with thicker internal septations. The lesion demonstrates cortical expansion and involves a substantial portion of the vertical mandibular height, commonly associated with odontogenic tumors such as ameloblastoma or odontogenic keratocysts. The radiographic presentation is indicative of a slow-growing but locally aggressive intraosseous pathology. Educational focus includes the recognition of multilocular radiolucencies in oral and maxillofacial radiology and the differential diagnosis of mandibular cystic and neoplastic lesions based on internal trabeculation patterns.

This diagnostic image is an Orthopantomogram (OPG), a panoramic dental X-ray, demonstrating a large pathological lesion in the mandible. The primary finding is a well-defined yet irregular radiolucent lesion located within the left mandibular body, indicated by a white arrow. The lesion exhibits significant osteolytic activity, resulting in the destruction of the surrounding medullary and cortical bone. The adjacent dentition shows clinical complications, including missing teeth in the left mandibular quadrant and evidence of dental caries in the remaining teeth bordering the mass. The radiographic appearance of the radiolucent area, combined with the irregular margins and localized bone destruction, is suggestive of an odontogenic tumor or carcinoma, such as clear cell odontogenic carcinoma or ameloblastoma. This image is used in dental and maxillofacial education to illustrate the radiographic presentation of aggressive mandibular neoplasms and the importance of panoramic imaging in identifying bone-destroying lesions of the jaw.

This orthopantomogram (panoramic dental X-ray) of a pediatric patient displays a large, bilateral expansile osteolytic lesion within the body of the mandible. The pathology is characterized by a significant area of radiolucency extending across the midline, involving both the right and left mandibular bodies. The lesion features well-defined, sclerotic margins, indicating a slow-growing process. Its expansile nature is evidenced by the thinning and outward bowing of the mandibular cortex. Notably, the lesion causes displacement of developing permanent teeth and molar roots, which is a common finding in intraosseous vascular malformations (AVMs) or giant cell lesions. Two white arrows highlight the lateral extents of the radiolucent area. This diagnostic image is used to illustrate primary dental/maxillofacial radiology findings for osteolytic jaw lesions and is essential for the differential diagnosis of mandibular bone expansion in young patients.

Imaging modality: dental panoramic radiography (Orthopantomogram, OPG) provides a single broad, two-dimensional view of the jaws and dentition. The lesion is located in the mandible, most likely in the posterior region, with a conspicuous radiolucent, multiloculated pattern described as a soap-bubble appearance. The borders are corticated but expanded, indicating benign but locally aggressive behavior. Teeth in the vicinity show displacement and possible root resorption; there are no radiopaque calcifications within the lesion. This radiographic phenotype is characteristic of ameloblastoma, an epithelial odontogenic tumor that comprises about 1% of jaw tumors and cysts. The differential diagnosis includes odontogenic keratocyst, central giant cell granuloma, odontogenic myxoma, and other multilocular jaw lesions. Clinically, ameloblastoma presents in young to middle-aged adults as slow-growing swelling with facial asymmetry, often without pain. Imaging assessment informs surgical planning, as complete en bloc resection or wide local excision is often required due to high recurrence rates if the lesion is incompletely removed. Correlate radiographic findings with histopathology for definitive diagnosis. The image is credited to Bulent Celasun, MD, Ankara, Turkey, with permission. This depiction reinforces radiographic hallmarks used in educational and diagnostic workflows. Biopsy confirmation remains essential to establish definitive histology and guide definitive management and long-term surveillance.

This orthopantomogram (panoramic X-ray) of the human mandible reveals a significant diagnostic finding in the right mandibular body extending toward the symphysis. The image displays a large, well-defined multilocular radiolucent lesion characterized by two distinct internal architectural patterns: a 'honeycomb' appearance, consisting of numerous small, uniform radiolucent compartments separated by thin radiopaque septa, and a 'soap bubble' pattern featuring larger, more irregular circular radiolucencies with thicker internal septations. The lesion demonstrates cortical expansion and involves a substantial portion of the vertical mandibular height, commonly associated with odontogenic tumors such as ameloblastoma or odontogenic keratocysts. The radiographic presentation is indicative of a slow-growing but locally aggressive intraosseous pathology. Educational focus includes the recognition of multilocular radiolucencies in oral and maxillofacial radiology and the differential diagnosis of mandibular cystic and neoplastic lesions based on internal trabeculation patterns.

This diagnostic image is an orthopantomogram (OPG) or panoramic radiograph of the human mandible and maxilla. The central finding is a large, well-defined multilocular radiolucency with a characteristic 'soap bubble' appearance, prominently highlighted by red arrows. The lesion involves a significant portion of the mandibular body, extending bilaterally across the symphysis from approximately the lower left first premolar (tooth 34) to the lower right second molar (tooth 47). Notable secondary effects include the obliteration of root apices for teeth 31 through 34 and 41 through 46, and significant thinning of the inferior cortex of the mandible. Several anterior teeth exhibit endodontic filling material. The radiographic presentation is highly suggestive of an odontogenic tumor, such as an ameloblastoma. The image demonstrates key concepts in dental radiology, including multilocular lesion morphology, root resorption, and cortical thinning, serving as a critical educational example for oral and maxillofacial pathology.

This diagnostic image is a preoperative orthopantomography (panoramic X-ray) of an adult human skull focusing on the dentomaxillofacial complex. The primary pathology is a large, well-defined multilocular radiolucency located in the left mandible. The lesion exhibits a 'soap bubble' or 'honeycomb' appearance characteristic of an ameloblastoma, extending from the left mandibular lateral incisor (tooth 3.2) posteriorly through the molar region (tooth 3.8) and into the ascending ramus. Significant cortical thinning and displacement of the surrounding dental roots are visible. Associated dental findings include several radiopaque endodontic treatments with intraradicular posts in the right mandibular premolars and a large radiopaque crown restoration in the left maxillary molar region. Anatomical landmarks such as the maxillary sinuses, nasal cavity, mandibular condyles, and temporomandibular joints are visible bilaterally. The image serves as a clinical example of odontogenic tumor presentation and is intended for intermediate to advanced oral and maxillofacial pathology education.

Histology: Light microscopy of a jaw lesion shows classic ameloblastoma morphology on hematoxylin and eosin stained tissue. The neoplasm is composed of multiple epithelial islands and cords embedded in a fibrous connective tissue stroma. Follicular pattern predominates, with nests of odontogenic epithelium displaying peripheral palisading of columnar cells and reversal of polarity, nuclei oriented away from the basement membrane. Central cells resemble stellate reticulum with loosely arranged, angular morphology. Some islands exhibit a loosely arranged, anastomosing arrangement compatible with plexiform architecture. Overall cellularity is moderate, with minimal pleomorphism and no overt mitotic activity in the field, consistent with benign but locally aggressive behavior. Basal layer cells are darkly basophilic with prominent nucleoli, while surrounding stroma is densely fibrous and occasionally myxoid, producing a subtle desmoplastic impression in portions of the section. The tumor borders appear infiltrative into adjacent connective tissue, reflecting its known propensity for local invasion despite benign cytology. There is an absence of keratinization, dysplasia, or metastatic features. The image highlights the diagnostic hallmarks: enamel organ–like islands, reverse polarity, stellate reticulum–like center, and a fibrous stroma. These histologic features underline confirmation of diagnosis and guide surgical planning in odontogenic tumors and jaw neoplasms. For educational and diagnostic purposes.

This histopathology slide, stained with Hematoxylin and Eosin and viewed under brightfield light microscopy at low to mid magnification, demonstrates classic plexiform ameloblastoma architecture within the jaw. Neoplastic odontogenic epithelium forms interconnected cords and anastomosing strands embedded in a loose, highly vascular stroma of fibrous connective tissue. The epithelial cords are composed of basaloid cells with peripheral cells often lacking the typical palisading and reverse nuclear polarity; within the cords, cells are more loosely arranged, resembling an inner stellate reticulum. Cystic change is uncommon in this plexiform subtype. The overall pattern shows benign cytology but a propensity for local invasion and bone destruction clinically. These features support the diagnosis of ameloblastoma, plexiform type, and help distinguish it from other odontogenic tumors and jaw cysts. Diagnostic significance includes confirming a locally aggressive, benign neoplasm that necessitates wide surgical excision with clear margins to minimize recurrence. Clinically, this pattern correlates with gradual cortical expansion and radiographic lytic lesions in the mandible or maxilla. In educational settings, the image is valuable for teaching odontogenic histology, subtyping ameloblastoma, and illustrating variations among follicular, plexiform, and desmoplastic patterns. Correlation with radiographs (multilocular radiolucencies) and clinical jaw swelling reinforces a multidisciplinary management approach.

This histology image depicts ameloblastoma of the jaw, captured on a hematoxylin and eosin–stained biopsy section examined under light microscopy. The dominant pattern shown is follicular ameloblastoma, with oval to rounded islands of odontogenic epithelium embedded in a dense fibrous stroma. Peripheral columnar cells exhibit classic reverse polarity and peripheral palisading, while the central cells resemble the stellate reticulum of the developing tooth germ. In some regions, the epithelial nests are triangular or elongated and dispersed, consistent with alternate patterns that may coexist in the same tumor, including plexiform, acanthomatous, basaloid, granular cell, or desmoplastic variants. The nests are separated by a mature, hyalinized connective tissue stroma without prominent inflammatory infiltrate. The myxoid or hyalinized stroma and highly organized epithelial architecture help distinguish ameloblastoma from other odontogenic lesions. Clinically, these histologic features correlate with locally aggressive behavior despite benign cytology, underscoring the need for complete surgical excision with clean margins to minimize recurrence risk. The image emphasizes the diagnostically relevant hallmarks—pigmented? No, not pigmented; but rather cohesive islands with peripheral palisading and stellate reticulum core. This slide serves educational value for surgical planning, differential diagnosis, and radiologic-pathologic correlation in jaw lesions. It is suitable for teaching, research, and case documentation.

This intraoperative clinical photograph captures a surgical field during a complex maxillofacial reconstruction. The image shows a microvascularized fibula bone flap being used to reconstruct a mandibular defect following tumor resection for ameloblastoma. A contoured metallic reconstruction plate is secured across the osteotomized bone segments with multiple surgical screws, providing rigid internal fixation and maintaining the anatomical contour of the lower jaw. The surgical site demonstrates exposed skeletal structures, subcutaneous fat, and muscle tissue, with several metal retractors positioned to maintain exposure. A vascular pedicle is visible, essential for the survival of the free flap. This visual serves as an educational example of advanced reconstructive surgery, highlighting the application of rigid fixation plates in stabilizing bone grafts during mandibular continuity restoration.

This clinical photograph captures an intraoperative view of a complex oral and maxillofacial reconstruction using a fibula free flap (FFF). The surgical site reveals a large mandibular defect being restored with a vascularized fibula bone graft. Key anatomical landmarks include the maxillary teeth and hard palate providing superior orientation. The transplanted fibula is contoured at its distal end to function as a neo-condyle, positioned within the native glenoid fossa to reconstruct the temporomandibular joint (TMJ). Rigorous internal fixation is achieved via metallic osteosynthesis plates and screws, securing the fibula segments to the remnant mandible. The image also demonstrates the soft tissue component of the flap and the associated vascular pedicle, essential for microvascular anastomosis. This procedure illustrates a standard approach for functional and aesthetic restoration following radical mandibular resection, highlighting the integration of the neo-condyle with the remnant joint capsule to maintain jaw mobility.

This composite of four clinical photographs illustrates a mandibular reconstruction using a free fibula flap guided by MOPITS (mandibular and osteotomy precision-improving template system). (a) Intraoperative view of a significant mandibular defect following tumor resection. (b) Preparation of the donor fibula segment; a clear resin surgical template is secured with screws to guide precise osteotomies and shaping of the bone. (c) The harvested fibular segment and associated skin paddle, featuring a pre-bent titanium reconstruction plate affixed to the bone to replicate the mandibular contour. The green arrow indicates the vascular pedicle containing the peroneal artery and veins for microsurgical anastomosis. (d) The final reconstruction stage, showing the vascularized fibular flap secured to the native mandibular remnants with the titanium plate and screws, restoring the anatomical continuity of the lower jaw. This surgical series demonstrates oral and maxillofacial reconstructive techniques, emphasizing the use of 3D-planned surgical guides for accuracy in free tissue transfer.

Histopathology slide of a jaw-based unicystic ameloblastoma, luminal subtype. Modality: light microscopy on hematoxylin and eosin-stained tissue, displaying a simple unilocular cyst with a fibrous wall. The cyst lining comprises ameloblastic epithelium with a tall columnar or cuboidal basal cell layer showing reverse nuclear polarity and peripheral palisading. The superficial cells toward the lumen resemble loosely cohesive stellate reticulum-like cells. The epithelium demonstrates luminal confinement, with no clear invasion into the cyst wall in this field. Intraluminal nodules or mural islands may be seen in other variants, but this specimen emphasizes luminal growth. Surrounding stroma is generally desmoplastic and collagenous without frank invasion by island in this view. Alternative terminology includes “odontogenic tumor” and “ameloblastoma variant” for educational clarity. Diagnostic significance: pattern supports a unicystic, luminal configuration with relatively favorable prognosis compared with multicystic forms, though recurrence risk persists if mural or intraluminal components are present. Relevant differential diagnoses include dentigerous cyst, inflammatory odontogenic cyst, and conventional solid/multicystic ameloblastoma. Clinically, histopathology guides surgical planning (enucleation vs resection) and informs prognosis; this image is valuable for oral pathology education, radiology-pathology correlation, and case-based learning in maxillofacial tumor pathology. This content supports learners in recognizing histologic patterns and correlating with radiographs globally.

Histology: Light microscopy; Hematoxylin and Eosin (H&E) stained section of a unicystic ameloblastoma arising in the mandible. The specimen is a cystic lesion, typically associated with an unerupted third molar, showing a well circumscribed cavity lined by ameloblastomatous epithelium. The lining displays basal palisading of columnar cells with reversed nuclear polarity and an overlying zone resembling stellate reticulum. In many fields there are intraluminal or mural tumor nests within the cyst wall, representing the proliferative component. The surrounding stroma is usually fibrous and vascular, sometimes with mild inflammation. Clinically and radiographically, the lesion can mimic a dentigerous cyst, primordial cyst, radicular cyst, or residual cyst; histopathology confirms ameloblastic differentiation and classifies it as unicystic variant. Pathologic diagnosis has prognostic significance because involvement limited to the cyst lining (luminal or simple unicystic) has a favorable prognosis with conservative enucleation, while invasion of the cyst wall (mural unicystic) or solid nodules increases recurrence risk and may require more aggressive resection. Potential clinical uses include surgical planning, radiologic-pathologic correlation, and educational differentiation of odontogenic cystic lesions. This image exemplifies the diagnostic interface between histology and radiology in juvenile jaw lesions and odontogenic tumors.

Modality: Brightfield light microscopy of hematoxylin and eosin stained histologic section from a jaw lesion. Specimen: cyst wall/tissue obtained from a presumed unicystic ameloblastoma of the mandible. Location: odontogenic tumor arising in the jaw; microscopic segment shows cystic architecture lined by ameloblastoma‑type epithelium with islands of tumor cells embedded in a fibrous stroma. The epithelial lining exhibits basal palisading of columnar cells with reverse polarity and a loosely formed stellate reticulum‑like center; in the mural variant, tumor islands infiltrate the fibrous cyst wall. The surrounding stroma is densely collagenous with scant inflammation; keratinization is minimal. The slide demonstrates classic features that overlap with odontogenic cysts but, in focal areas, demonstrates proliferating ameloblastomatous nests consistent with unicystic ameloblastoma. Clinically, unicystic ameloblastoma is often misdiagnosed as a dentigerous cyst; definitive diagnosis requires microscopic sampling and histopathologic subtyping into luminal, intraluminal, or mural variants. Prognosis and treatment depend on subtype; luminal and intraluminal lesions are typically managed by enucleation with close follow‑up, whereas mural invasion warrants more extensive resection due to higher recurrence (reported 10–20%, greatest risk with mural type). Long-term surveillance is essential given the potential for late recurrences and the need for radiographic monitoring.