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45-Year-Old Female with Progressive Facial Swelling
This case features a 45-year-old female presenting with progressive facial swelling, ultimately diagnosed with gnathic osteosarcoma.
Imaging overview:
Axial, coronal, and sagittal contrast-enhanced CT demonstrates an expansile, destructive aggressive bony mass of the maxilla with periosteal reaction in a sunburst pattern. The mass causes significant osseous destruction with associated soft tissue extension. Widening of the periodontal ligament space surrounding involved teeth, known as the Garrington sign, is an associated CT finding indicative of aggressive tumor invasion into alveolar bone. MRI is utilized to evaluate soft tissue and intramedullary extension for local staging.
Clinical insight:
Gnathic osteosarcoma accounts for approximately 6 to 7% of all osteosarcomas and most commonly presents with pain and swelling of the maxilla or mandible, with an average patient age of 30 to 40 years, somewhat older than the peak incidence of conventional osteosarcoma. The sunburst periosteal reaction on CT is a hallmark of aggressive bone-forming tumors. The Garrington sign, referring to widening of the periodontal ligament space on CT, is a characteristic and diagnostically useful feature of gnathic osteosarcoma reflecting tumor invasion of the alveolar bone. MRI is essential for evaluating intramedullary and soft tissue extent to guide surgical planning and local staging.
Case courtesy of Julianna Wolochuk and Neelu Jain, MD, Temple University Hospital.