Variations and thicknesses of anterior belly of the digastric muscle: an ultrasonographic study.

PURPOSE: This study aims to evaluate the anatomy and anatomical variations of the anterior belly of the digastric muscle. METHODS: Hundred and fifty one ultrasonographic images of the digastric muscle pairs were evaluated in Near East University Faculty of Dentistry Department of Dentomaxillofacial Radiology. Morphological variations were recorded using the classification of the digastric muscle into 12 types by Kim et al. For the analysis, the Mann-Whitney U test and Chi-square test were used, and for the correlational analysis, Spearman's rho test was applied. P < 0.05 was considered statistically significant in all tests. RESULTS: Seventy female and 81 male patients aged 19-60 years were evaluated. Type 1 digastric muscle was observed in 145 of 151 patients, Type 2 in 3 patients, and Type 7 in 3 patients. The thicknesses of the right and left digastric muscles were measured, and a statistically significant difference was observed between the groups when the genders were compared. It was observed that both right and left digastric muscle thicknesses were higher in males than females. There was a statistically significant positive high correlation between right and left digastric muscle thicknesses (p = 0.000; r = 0.736). No statistically significant difference was found between genders (p = 0.596) in terms of anatomical variations. CONCLUSION: Considering that the variations of the digastric muscle may have a clinical significance role, the normal anatomy and variations of this muscle should be well known by maxillofacial surgeons and radiologists.

The use of intraoral ultrasound in the evaluation of the benign lesions in pediatric patients.

Ultrasonography (US) or diagnostic sonography is a radiographic technique that uses sound waves with frequencies higher than 20 kHz to demonstrate soft tissues such as muscles, internal organs, joints, and tendons. The US has various applications in dentistry such as cervical lymph node examination, salivary gland examination, periodontal examination, maxillofacial fracture examination, temporomandibular joint examination, and orofacial swelling examination. One of the most important advantages of the US is it does not produce any ionizing radiation. Since the US does not produce any ionizing radiation, it is a favorable technique especially for the patients who are susceptible to ionizing radiation such as pregnant patients and pediatric patients. In this article, we presented benign tumor lesions that were examined with the US in children and conducted a review of the literature.

Radiological examination of the relationship between the pterygomaxillary junction and fracture pattern.

BACKGROUND: Le Fort 1 (LF1) osteotomies are widely used to correct midface deformities. To move the maxilla freely, the ptery-gomaxillary junction (PMJ) must be separated. When performing this osteotomy, the pterygoid plate must remain intact. The objective of this study was to evaluate relationship between the anatomical features of the PMJ and fracture patterns in LF1 osteotomy. METHODS: Pre-operative and post-operative cone-beam computed tomography images of 41 patients (82 samples) who have undergone LF1 osteotomy surgery were radiologically evaluated. Morphologic measurements of the pterygomaxillary fissure area and pterygoid plate were carried out. Moreover, pterygomaxillary separation was divided into the clean-cut, maxillary sinus, and pterygoid plate fracture types. RESULTS: Statistically significant difference was observed between clean-type fracture and pterygoid plate fracture groups' thickness of the pterygoid process and thickness of the pterygomaxillary region. CONCLUSION: Anatomical variations make it difficult to separate the PMJ properly. Low thickness of PMJ increases the risk of unwanted fractures; however, according to our experience, the use of an osteotome with an incorrect angle, excessive force, and inexperienced surgeons can also cause undesirable pterygoid plate fractures.

A CBCT Study for Anatomic Variations of Osteomeatal complex in Patients With Cleft Lip and Palate.

OBJECTIVE: To evaluate the anatomy and variations of osteomeatal complex (OMC) by comparing patients with nonsyndromic cleft lip and palate (CLP) and control group. DESIGN: This case-control study was retrospectively analyzed using cone-beam computed tomography data. SETTING: Istanbul University Faculty of Dentistry Department of Dentomaxillofacial Radiology. PATIENTS: The study was conducted with 100 patients (44 females, 56 males) with CLP and 100 patients in the control group, which matched gender and age (with a maximum difference of 3 years). VARIABLES: OMC variations are grouped as follows: ethmoidal, conchal, uncinate process, and septal variations. Then, we evaluated the presence of these OMC variations and compared them between the two groups. STATISTICAL ANALYSIS: The McNemar's test was used to determine any significant differences between the groups for all indices at the 95% confidence level. RESULTS: The most common anatomic variation in this study was Agger nasi cell (97%) and concha bullosa (97%) in the patients with CLP, while Agger nasi cell was the most common variation (99%) in the controls. Moreover, the atelectatic uncinate process was the least observed variation in both groups (1%). The incidences of paradoxical concha (58%;42%), bifid concha (29%;11%), deviated nasal septum (92%;80%) were significantly higher in the CLP group (p < 0.05). CONCLUSIONS: The statistically significant results found when comparing OMC anatomy between the two groups reveal the importance of three-dimensional evaluation before functional endoscopic sinus surgery in patients with CLP.

Association of accessory sphenoidal septum with protrusions of sphenoid sinus.

PURPOSE: Accessory sphenoidal septum (ASS) is a septal variation that exists in addition to the primary septum of the sphenoid sinus and can be found in or near anatomically essential structures. This study aimed to investigate the relationships between protrusions of vital structures around the sphenoid sinus and the ASSs. METHODS: This cross-sectional retrospective study is based on the analysis of CBCT scans of 314 patients in axial, coronal, and sagittal planes with 0.2-0.3 slice thicknesses. Optic nerve (ON), internal carotid artery (ICA), both ON and ICA, maxillary nerve (MN), vidian canal (VN) and ASSs were detected, and the relationship between protrusions of these vital anatomical structures and ASS was evaluated. RESULTS: Statistically significant relationship was observed between the right Type 1 ON protrusion (p < 0.05) and left Type 1 ON protrusion (p = 0.001); left Type 3 ON protrusion (p < 0.05); right Type 4 ON protrusion (p < 0.05) and ASS. Statistically significant relationship was also observed between the right ICA protrusion and ASS (p < 0.05). The right Type 1 VN protrusion (p = 0.001); left Type 2 VN protrusion (p < 0.001); right and left Type 3 VN protrusions (p < 0.001) were found to be significantly associated with the ASS. CONCLUSIONS: ASSs have significant associations with some protrusions, and they tend to cause potentially severe complications in endoscopic sinus surgery. This variability requires a comprehensive understanding of regional sphenoid sinus anatomy with detailed three-dimensional tomographic imaging.

Physiologic intracranial calcifications incidentally detected on cone beam computed tomography.

OBJECTIVES: This study aims to determine the incidence of physiologic intracranial calcifications on cone beam computed tomography (CBCT) and to contribute to the differentiation between physiologic and pathologic intracranial calcifications by sharing their characteristic appearances, with the largest number of patients in the literature and many different types of physiologic calcifications. STUDY DESIGN: CBCT images of 996 patients admitted to the clinic between 2018 and 2019 were scanned retrospectively. Petroclinoid (PCL) and interclinoid ligaments (ICL), pineal gland, coronoid plexus, falx cerebri, tentorium cerebelli, and other dural calcifications were evaluated in each radiograph. RESULTS: Physiologic calcification was present in 49.4% of the cases, and pineal gland calcification was the most common (47.6%) type. PCL calcification was detected in 22.1%, and it was mostly bilateral partial. There were complete ICL in 1.2%, coronoid plexus in 11.3%, falx cerebri in 6.3%, tentorium cerebelli in 1.1%, and other dural calcifications in 3.6%. Only PCL calcifications differed between sexes and were more common in males. PCL, pineal gland, and coronoid plexus calcifications were most detected in the third decade of the cases. CONCLUSIONS: Intracranial calcifications are detected incidentally in CBCT examinations. Some calcifications may indicate pathologic conditions, and patients may need to be referred for further evaluation.

Radiological evaluation of the periosteal reactions in the jaws: a retrospective CBCT study.

OBJECTIVES: The objective of this study is to evaluate the relationship between the radiological features of periosteal reactions (PR) and histopathological features of the lesions. METHODS: A total of 4605 CBCT images were evaluated and they were classified according to their radiological differential diagnosis. Images with pathologies were listed according to their histopathological examinations as cystic lesions, benign tumours, malignant tumours, fibro-osseous lesions and osteonecrosis, while images without pathologies were listed as traumas and others. All groups were reclassified as with or without the presence of detected PR. RESULTS: Pathologies and traumas were detected in 1801 of 4605 patients. There were 3 PR in 1140 cystic lesions, 4 PR in 102 benign tumours, 16 PR in 43 malignant tumours, 67 PR in 156 osteonecrosis/osteomyelitis cases and 3 PR in 262 trauma cases. As a result of the chi-square test between groups, there was a significant relationship between histopathologic diagnoses and periosteal reaction patterns (p = 0.000). CONCLUSIONS: Although there is a significant overlap between the patterns of PRs, PRs can be used to narrow the possibilities in the differential diagnosis. However, PRs alone are not sufficient variables for differential diagnosis in the absence of cortical bone destruction, localization, clinical and systemic findings.

Ultrasonographic evaluation of the titanium-prepared platelet-rich fibrin effect in free gingival graft procedures.

BACKGROUND: Complications after free gingival graft (FGG) operations are generally related to the donor site. The titanium-prepared, platelet-rich fibrin (T-PRF) placement in the donor site accelerate the wound healing and prevent postoperative complications such as pain and hemorrhage. We aim to evaluate the effect of T-PRF regarding vascularization and tissue thickness and to report the advantages of the ultrasonography (US) in FGG. METHODS: Ten individuals were divided into two groups as T-PRF and control. While the T-PRF membrane was placed at the donor site in the T-PRF group, a gelatin sponge was placed in the control group. All patients underwent US examination in terms of vascularization and tissue thickness of left and right donor sites. The correlation between the right and left donor sites was analyzed with the Pearson correlation test. Tissue thicknesses and pulsatility index (PI) were analyzed with independent samples t-test. The results were evaluated statistically at the P <0.05 significance level. RESULTS: The T-PRF group showed increased vascularity which can be interpreted to improve healing in soft tissue. However, not a difference, but a positively very high correlation was observed between the right and left tissue thicknesses (P = 0,00; r = +0902). CONCLUSIONS: Evaluation of tissue thickness and vascularization density of donor sites with US not only increases clinical success rate but also reduces the risk of complications during surgery and postoperative pain in FGG. Studies evaluating T-PRF membrane as palatal dressing after FGG are only clinical, however, the efficiency of T-PRF was evaluated radiologically in this study for the first time.

Osteolipoma: a review of the literature and a rare case report.

OBJECTIVES: Lipomas are the most common benign mesenchymal tumors of soft tissue. According to previous studies, 1-4% of the cases has been observed in the oral cavity. A histological variant of lipoma featuring bone formation is called osteolipoma and has been very rarely observed (less than 1% of the total). In order to make a meaningful addition to this rare knowledge base, our study aims to provide a literature review and to report an additional case of osteolipoma. METHODS: An electronic search in the PubMed database with the keyword "osteolipoma" was conducted. Among 69 search results, only the cases of osteolipoma located in the "oral cavity" were included in this study. The findings of the previously reported 20 cases (in English) of osteolipoma of the oral cavity were organized in a table along with a new case of osteolipoma located in the mandibular buccal vestibule with radiological and histopathological findings provided by the authors. RESULTS: Osteolipoma affects both sexes and usually emerges in middle-aged or elderly patients with a long history of slow progression. Different imaging techniques may be utilized in the radiographic evaluation. CONCLUSION: Differential diagnosis includes a wide range of lesions; therefore, the clinical and radiographic evaluation should be confirmed by histopathological examination. The suggested treatment is complete surgical excision and follow-up, and the prognosis is generally good.

Craniofacial Fibrous Dysplasia Involvements of Mccune-Albright Syndrome: A Review with an Additional Case.

BACKGROUND: McCune-Albright Syndrome (MAS) is a genetic disorder with a triad of endocrine diseases, café-au-lait macules and fibrous dysplasias. Craniofacial fibrous dysplasia is a term that is used to describe the fibrous dysplasia, which was localized at the craniofacial skeleton and is common in MAS patients. OBJECTIVE: The objective of this review is to determine the involvement frequency of cranial and facial bones in patients with MAS and CFD. METHODS: Articles in PubMed was searched with the following details "(mccune[Title/Abstract] OR albright[Title/Abstract]) OR ("craniofacial fibrous dysplasia"[MeSH Terms] OR ("craniofacial"[ All Fields] AND "fibrous"[All Fields] AND "dysplasia"[All Fields]) OR "craniofacial fibrous dysplasia"[All Fields])". The articles in which the authors did not state the involved bones or did not add any radiographic images were excluded from the study. RESULTS: 26 cases in 25 articles met the inclusion criteria. Among the 26 cases and our case, sphenoid and frontal bones were involved in 17 cases, parietal and occipital bones were involved in 15 cases, mandible and ethmoid bone were involved in 14 cases, maxilla-zygoma-temporal and palate was involved in 13, 11, 6 and 3 cases, respectively. Palate was involved in cases where maxilla was also involved. Our case was the only case that was evaluated with CBCT. CONCLUSION: Routine follow-ups are important since new CFDs can occur in different cranial or facial bones. 2D imaging techniques may not be able to demonstrate early CFDs; thus, an advanced imaging technique should be used after MAS diagnosis.

A review with an additional case: amelanotic malignant melanoma at mandibular gingiva.

The purpose of this review with an additional case is to evaluate the clinical, ultrasonographic and histopathological features of a rare case of Amelanotic Malignant Melanoma (AMM) at mandibular gingiva and to compare our case with other published AMMs at mandibular gingiva. A 52-year-old male patient with no systemic diseases was referred to our clinic with a soft tissue lesion at mandibular gingiva. Ultrasonographic examination was performed and a lesion with malignant features was observed. A periapical radiograph was taken to investigate bone destruction and biopsy was planned. Histopathological examination revealed AMM and a literature search was performed to congregate reports which were indexed in PubMed, ScienceDirect, and ResearchGate. Three AMM cases at mandibular gingiva were found. Doppler Ultrasound examination suggested bone destruction and a 1.8 cm × 0.6 cm soft tissue mass with well-defined borders and increased vascularity. Due to its hypervascularity, depth of invasion and destruction at the bone, the lesion was prediagnosed as a malignancy. Lack of melanin pigmentation caused the large immunohistochemical panel study. The tumour cells showed HMB45 and S100 positivity and they were negative with SMA, Desmin, CK1.3, and CK20. Routine ultrasound examination of all soft tissue lesions is very important for assessing features such as vascularity, bone destruction and depth of invasion to detect malignancy. Melanocytic-associated immunohistochemical markers are crucial for AMM diagnosis.

Clinical and radiological evaluation of cherubism: A rare case report.

Cherubism is a rare, non-neoplastic, genetic disorder, characterized by painless bilateral swelling of the jaws. A 5-year-old girl presented with a painless, bilateral symmetrical swelling of both mandible and maxilla. Intraoral examination revealed malocclusion with displacement of teeth and expansion of the alveolar ridges. There was a bilateral expansion of the jaws. In conclusion, cherubism is a genetic disorder that has non-neoplastic bone lesions that affect the jaws. If there is a functional or esthetic problem, it should be treated surgically. The surgical treatment is usually delayed until after puberty.

Evaluation of Radiolucent Lesions Associated with Impacted Teeth: A Retrospective Study.

BACKGROUND: Impacted teeth are commonly asymptomatic and not associated with any pathologic lesions for years. Any change in the size of the follicle associated with impacted teeth may result in odontogenic cysts or tumors. CBCT plays an important role in determining the radiographic features of a lesion and therefore, is very helpful for accurate diagnosis and treatment planning. OBJECTIVE: This study aims to evaluate radiolucent lesions associated with impacted teeth in terms of age and sex distribution, localization, and comparison with the pathological diagnosis. METHODS: In this retrospective study, out of 6758 CBCT images, 400 images revealing radiolucent lesions were detected. The study included only 190 cases (regarding 180 patients) which had a matching histopathological evaluation. Data related to the age and sex of the patients, localization of the lesions, and their comparison with the pathological diagnosis were recorded and analyzed. RESULTS: The most encountered lesions were dentigerous cysts (60%) and odontogenic keratocysts (26.3%). Males were the most affected (63.3%). Most of the lesions were found in the left and right posterior mandible and mostly (66.8 %) associated with third molars. Out of 123 radiological diagnoses of dentigerous cyst cases, histopathological diagnoses confirmed 108 cases. Regarding odontogenic keratocyst, histopathological diagnosis confirmed 40 cases out of 48. CONCLUSION: Radiological diagnoses of the lesions mostly match with their pathological diagnosis unless their characteristics are changed due to infection. CBCT, as a technique enabling detailed imaging of the involved dental structures, is a helpful instrument for differential diagnosis.

Prevalence of pneumatization of the articular eminence and glenoid fossa viewed on cone-beam computed tomography examinations in a Turkish sample.

OBJECTIVE: The aim of this study is to evaluate the prevalence of the pneumatization of the articular eminence and glenoid fossa (PAT and PGF, respectively) using cone-beam computed tomography (CBCT). METHODS: CBCT images of 1000 patients (511 females and 489 males) representing 2000 regions of interest (the glenoid fossa and articular eminence of each patient) were examined retrospectively with regard to age, gender, laterality, and type of pneumatization. The mean age of the female patients was 39.66 and that of males was 39.79. Suitable images from patients aged 16 years and over found in the archives of CBCT images were included in the study. The data were assessed using IBM SPSS 20 and statistical comparisons between two categorical variables were conducted using Chi square tests. RESULTS: It was observed that 14.7% of the patients had PAT and 47.1% had PGF. There was no significant difference in PAT and PGF prevalence between ages, age ranges, and gender in our study (p > 0.5). CONCLUSIONS: It is important to evaluate the pneumatic cells in the articular eminence and glenoid fossa regions before surgery. It was also found that CBCT is more helpful in detecting pneumatization than plain film.

Significance of the Tks4 scaffold protein in bone tissue homeostasis.

The main driver of osteoporosis is an imbalance between bone resorption and formation. The pathogenesis of osteoporosis has also been connected to genetic alterations in key osteogenic factors and dysfunction of bone marrow mesenchymal stem/stromal cells (BM-MSCs). Tks4 (encoded by the Sh3pxd2b gene) is a scaffold protein involved in podosome organization. Homozygous mutational inactivation of Sh3pxd2b causes Frank-ter Haar syndrome (FTHS), a genetic disease that affects bone tissue as well as eye, ear, and heart functions. To date, the role of Tks4 in adult bone homeostasis has not been investigated. Therefore, the aim of this study was to analyze the facial and femoral bone phenotypes of Sh3pxd2b knock-out (KO) mice using micro-CT methods. In addition to the analysis of the Sh3pxd2b-KO mice, the bone microstructure of an FTHS patient was also examined. Macro-examination of skulls from Tks4-deficient mice revealed craniofacial malformations that were very similar to symptoms of the FTHS patient. The femurs of the Sh3pxd2b-KO mice had alterations in the trabecular system and showed signs of osteoporosis, and, similarly, the FTHS patient also showed increased trabecular separation/porosity. The expression levels of the Runx2 and osteocalcin bone formation markers were reduced in the bone and bone marrow of the Sh3pxd2b-KO femurs, respectively. Our recent study demonstrated that Sh3pxd2b-KO BM-MSCs have a reduced ability to differentiate into osteoblast lineage cells; therefore, we concluded that the Tks4 scaffold protein is important for osteoblast formation, and that it likely plays a role in bone cell homeostasis.

Acceleration of Fracture Healing in Experimental Model: Platelet-Rich Fibrin or Hyaluronic Acid?

In this study, we compared the bone-healing effects of the local application of platelet-rich fibrin (PRF) and hyaluronic acid (HA) to bilateral tibial fractures in rats. Twenty-three adult male Sprague-Dawley rats were used. Twenty-two animals were randomly allocated to a control group (n = 6) and 2 study groups: PRF (n = 8) and HA (n = 8). The 23rd rat was used as a donor to obtain PRF. Each group was divided into 2 subgroups for histomorphometric and radiologic assessments at 2 and 6 weeks. Foreign body reaction, necrosis, inflammation, new bone formation, and fibrosis were investigated as bone healing parameters in terms of histopathologic analysis. The difference between the groups for these parameters was evaluated. The radiologic evaluation was performed by comparing the 3-dimensional reconstruction images of the fracture sites between the study and control groups. Histomorphometric evaluation showed that at 2 weeks postoperatively, the control group showed lesser bone formation (26.1 ±â€Š6.6%) when compared to the study (HA: 54.7 ±â€Š9.7%; PRF: 75.3 ±â€Š19.2%) groups and PRF group showed highest total ossification. At 6 weeks postoperatively the PRF group showed lesser total ossification (50.7 ±â€Š28.2%) when compared to control (76.3 ±â€Š21.7%) and HA group. The HA (88.8 ±â€Š13.3%) showed highest total ossification. In the control group, fibrosis was more prominent at week 6, whereas in the HA and PRF groups the amount of ossification increased. In contrast to histopathologic healing, radiologic bone healing did not differ significantly among the study and control groups 2 weeks after surgery, whereas at 6 weeks, the results of radiologic bone formation were in accordance with those of histopathologic bone healing.

Assessment of the trabecular structure of mandibular condyles in patients with temporomandibular disorders using fractal analysis.

OBJECTIVES: The aim of this study was to evaluate changes in the trabecular structure of the mandibular condyle in patients with temporomandibular disorders (TMDs) using fractal analysis. STUDY DESIGN: A total of 100 patients ages 18 to 73 years were clinically assessed using the Diagnostic Criteria for Temporomandibular Disorders. The control group was age- and sex-matched with the patient group. Panoramic radiographs were obtained using a Kodak 8000 digital device with 73 kVp and 5 mA fixed parameters. The degree of degeneration in the mandibular condyles was calculated. Regions of interest (84 × 84 pixels) were selected within the cortical boundary of the mandibular condyle, and the fractal dimension (FD) was calculated using ImageJ version 1.48. RESULTS: Radiographic degenerative changes were more frequently present and more severe in the patient group (P < .001). The mean value of FD was 1.22 ± 0.06 in the patient group and 1.25 ± 0.06 in the control group (P = .001). A significant decrease in FD was observed (P = .001) in the left temporomandibular joints of the patient group, whereas a nonsignificant decrease in FD was observed in the right temporomandibular joints (P = .073) as degenerative changes increased. CONCLUSIONS: Lower FD values were associated with more severe degenerative changes in the patient group. The trabecular structure of condyles in patients with TMD exhibited decreased complexity when erosive and sclerotic changes were evident. As a result, fractal analysis enhanced the use of panoramic radiography in detecting degenerative changes in patients with TMD.

Frank-ter Haar syndrome--additional findings?

Frank-ter Haar syndrome is a genetic disease that is transmitted by autosomal recessive pattern with characteristic features such as megalocornea or glaucoma, a prominent coccyx, heart defects, developmental delays, brachycephaly, a wide anterior fontanel, finger flexion deformities, full cheeks and micrognathia. Dentomaxillofacial features of this syndrome are not well documented in the literature. We present of a 21-year-old male with Frank-ter Haar syndrome and some features that may be linked with this syndrome not reported before in the literature.

Evaluation of dental panoramic radiographic findings in edentulous jaws: A retrospective study of 743 patients "Radiographic features in edentulous jaws".

PURPOSE: The aim of this study was to determine the frequency of significant panoramic radiographic findings and eventual treatment requirements before conventional or implant supported prosthetic treatment in asymptomatic edentulous patients. MATERIALS AND METHODS: A total of 743 asymptomatic edentulous patients were retrospectively evaluated using a digital panoramic system. We analyzed the radiographic findings, including impacted teeth, retained root fragments, foreign bodies, severe atrophy of the posterior maxillary alveolar bone, mucous retention cysts, soft tissue calcifications and radiopaque-radiolucent conditions. RESULTS: Four-hundred-eighty-seven (65.6%) patients had no radiographic finding. A total of 331 radiographic findings were detected in 256 (34%) patients. In 52.9% (n=175) of these conditions, surgical treatment was required before application of implant-supported fixed prosthesis. However, before application of conventional removable prosthesis surgical treatment was required for 6% (n=20) of these conditions. CONCLUSION: The edentulous patients who will have implant placement for implant-supported fixed prosthesis can frequently require additional surgical procedures to eliminate pathological conditions.

Recurrent cherubism in an adult patient.

Cherubism is an uncommon, nonneoplastic, fibro-osseous disorder of the jaws in childhood and adolescence. It affects the jaw bones by deforming the cortical shell. Clinical features include progressive painless and mostly bilateral expansion of the mandible and/or maxilla. Because fibrous connective tissue replaces osseous tissue, radiographic features generally include expansile osteolytic lesions and a ground-glass appearance. Several treatment protocols for cherubism have been recommended in the literature; however, despite surgical curettage treatment, recurrences may occur. Our aim was to emphasize the high recurrence rate of cherubic lesions. In this article, we present cherubism in a young girl that relapsed after 5 surgical operations before her appearance to our clinic.