Introduction: Lipomas are benign soft tissue tumors, characterized by the presence of mature adipocytes in histopathology. Their development is slow and their etiologies are still controversial. Frequently subcutaneous, this type of lesion is rarely present in the oral cavity. Observation: A 67-year-old man consulted for a nodule on the inner face of his right cheek which had been developing for several years, with severe discomfort during chewing. The typical clinical aspect of this lesion suggested a lipoma. Magnetic resonance imaging (MRI) was performed before surgical excision in order to establish a differential diagnosis with a well-differentiated liposarcoma. Comments: The various imaging examinations, particularly MRI, combined with the analysis of the fat component and the morphology of the non-fat component (septa) enable us to define several categories of lesions likely to have a benign or malignant character. However, some lesions remain difficult to classify, and it is the histopathological examination along with, if necessary, immunohistochemistry (anti-MDM2 and/or anti-CDK4), which allows to confirm or not the malignancy of a lesion. Histological examination suggested a fibrolipoma. Conclusion: Although benign, the size of a fibrolipoma may can lead to significant functional and aesthetic discomfort for the patient. Surgical excision remains the treatment of choice.

A 15-year-old girl with a history of recurrent painful orofacial swelling was diagnosed on the basis of clinical findings, histopathological examination and imaging modalities as having primary chronic osteomyelitis of the jaw. Initial microbiological samples were performed but were inconclusive. She received multiple empirical antibiotic therapies and NSAIDs for 3 years without complete remission. Only MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization–Time Of Flight) analysis after additional multiple microbiological bone samples with adequate techniques yielded the final diagnosis of bacterial chronic osteomyelitis of the jaw. Its management requires a multidisciplinary approach, involving oral and maxillofacial surgeons, infectiologists and microbiologists, to limit treatment failure. Antibiotic therapy without surgery for 6 months achieved the complete radiographic resolution of the CBCT (Cone Beam Computed Tomography) and the normalization of laboratory tests. After 2 years of follow-up, no relapse had been reported. Modern microbiological investigation and sampling techniques are critical for the accurate diagnosis and management of osteomyelitis of the jaw, especially in unusual and clinically misleading forms of this infection.

Introduction: Disseminated intravascular coagulation (DIC) is a complexe systemic disorder characterized by a widespread activation of the coagulation, that may lead to thrombosis, ischemia and finally, end-organ failure. The clinical presentation of DIC depends on the site of intravascular coagulation and the severity of the disease process. Avascular osteonecrosis is a pathological state, that can occur secondary to DIC and where a reduced vascular supply leads to ischemia and bone necrosis. Observation: A 83 years old patient was sent to the oral surgery department for tooth mobility in the premaxilla, following the diagnosis of sepsis and DIC induced acute myeloid leukemia, one month ago. The examination showed an exposed avascular bone behind the 12-11-21. A diagnosis of DIC induced osteonecrosis of the premaxilla was made. A resection surgery was then programmed. Discussion: DIC may generates thrombi that might occlude intraosseous vessels in the premaxilla, and lead to bone necrosis. The maxilla is supplied by multiple branches of external carotide artery, therefore, usually, there is a lower risk of osteonecrosis in the maxilla. Nevertheless, since 1993, 4 cases of avascular necrosis of the maxilla secondary to DIC are repported in literature. Conclusion: This kind of complication, although being rare, can be dramatic for the patient as bone and aesthetic defects. Early support and management of these complications is necessary.