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Clinical Problem Solving: Radiology |

Radiology Quiz Case 1

Thomas Walker; Theodore Chen, MD; Christopher M. Bergeron, MD; Nancy J. Fischbein, MD; Michael J. Kaplan, MD; Ashkan Monfared, MD
Arch Otolaryngol Head Neck Surg. 2008;134(3):328. doi:.
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A 55-year-old man presented with a 22-year history of an enlarging, ulcerating mandibular mass. He reported noticing a “pea-size” mass after a dental procedure and having an x-ray film that showed a “jaw tumor.” He did not initially seek medical attention because of his religious beliefs. Eventually, the mass ulcerated and over time made chewing impossible. The patient reported a 11-kg weight loss over the previous 2 years, without any loss of appetite.

Physical examination revealed a 32 × 32 × 5-cm firm mass involving most of the mandible. Two areas of skin ulceration were noted: one superiorly, measuring 15 × 12 cm, and one more inferiorly, measuring 4 × 2 cm. The mass involved the left floor of the mouth and nearly the entire mandible and displaced maxillary teeth. Cranial nerve examination did not demonstrate any deficits, and no lymphadenopathy was noted. The patient's medical history, family history, and social history were noncontributory. A computed tomographic scan (Figure 1and Figure 2), with 3-dimensional rendering (Figure 3and Figure 4), was obtained. The arrows in Figure 1 indicate the remnant of the right mandible, and the arrow in Figure 2 indicates the normal temporomandibular joint.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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