J Korean Assoc Oral Maxillofac Surg.  2025 Jan;51(1):59-66. 10.5125/jkaoms.2025.51.1.59.

Intraosseous xanthoma simultaneously treated with mandibular prognathism using sagittal split ramus osteotomy in the mandible: a case report and literature review

• Lee YS
• Youn SB
• Choi SG
• Do KL
• Namis S
• Seo BM

• KMID: 2565640
• DOI: http://doi.org/10.5125/jkaoms.2025.51.1.59

Abstract

Xanthomas are benign lesions characterized by the aggregation of lipid-laden histiocytes and foamy cells within tissues. Intraosseous xanthomas (IOXs), especially those in the jaw bone, are rare, with only around 50 cases documented. This case report describes an IOX located at an osteotomy site in the mandible during sagittal split ramus osteotomy (SSRO). Preoperative radiographs revealed a heterogenic radiolucent-radiopaque lesion in the right ramus. After meticulous curettage of the lesion, proximal and distal segments were fixed in the semi-rigid plates and screws. At the one-year followup, radiographs showed excellent bony union between proximal and distal segments, with no significant interval change. IOXs rarely occur in the jaw. However, their predilection for the posterior mandible suggests that such lesions can be encountered during orthognathic surgery. This report demonstrates the feasibility of performing SSRO directly through the lesion with concurrent curettage without compromising surgical outcomes. This case will contribute to the limited literature on IOX of the jaw bone and its treatment via SSRO as a feasible surgical option in concomitant orthognathic surgery.

Keyword

Intraosseous xanthoma; Sagittal split ramus osteotomy; Orthognathic surgery

Figure

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  Fig. 1 Preoperative radiographs. A. Panoramic view. B. Posteroanterior cephalogram. C, D. Axial cone-beam computed tomography images. All of these images were taken one month before surgery. A slight radiolucency was observed in the right ramus.

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  Fig. 2 Clinical photographs during sagittal split ramus osteotomy (SSRO). A. The lesion observed in the right ramus. B, C. The lesion was completely removed via surgical curettage before and after SSRO.

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  Fig. 3 Histopathological examination revealed pathologic features of the xanthoma. A. Hematoxylin and eosin staining revealed lipid-filled foamy macrophage (magnification, ×40). B. Cytoplasmic positivity for CD68 (magnification, ×40). C. Lesion cells lack S-100 expression (magnification, ×40).

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  Fig. 4 Follow-up panoramic view and posteroanterior (PA) cephalogram of 1 year after surgery. A. Panoramic view. B. PA cephalogram.

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  Fig. 5 Post-operative multidetector computed tomography (MDCT) taken one-year follow-up. A-C. Axial view. E-G. Coronal view MDCT images. Appropriate bony union was observed between segments, with no recurrence of the lesion.

Reference

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