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Archive for the ‘recurrence’ Category

Tonight I stayed up till 6:15am researching journals about ameloblastoma, bone grafts, etc. I’m keeping notes here.

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This came in the mail today:


[Patient] is 31 years old and presented for evaluation of radiolucent area in his posterior left mandible on December 4, 2008, as referred by his dentist, [Dentist]. A multi-centimeter diameter lesion was noted in the left ramus and was not associated with pain or anesthesia. There was notable expansion of the mandibular ramus and external oblique region. An incisional biopsy of the area was performed under local anesthesia on December 8, 2008, and submitted to Baylor College of Dentistry Oral Pathology Services for evaluation. The pathology report revealed an ameloblastoma within his mandible. A cone-beam image CT scan was performed on December 12, 2008, and I have reviewed that scan today. The lesion is large and extends from the anterior portion of the mandible in the distal first molar region to the posterior extent of it in the mid ramus below the mandibular condyle. There is significant expansion of the mandible, thinning of the cortices and root resoprtion of tooth #18. There is a possible perforation to the soft tissues on some of the lingual areas. There inferior alveolar nerve appears to be within very thin bone and displaced to the inferior quarter of the mandible.

[Patient] enjoys excellent general health. He is GI intolerant to erythromycin. Otherwise, he received a tonsillectomy at 8 years old, wisdom teeth extraction at 18 and partial gingivectomy for periodontal maintenance during the past year.

IMPRESSION:

  1. Patient is a 31-year-old man in good general health
  2. Ameloblastoma, large, left posterior mandible.

TREATMENT RECOMMENDATIONS

  1. Inform patient regarding the clinical findings and nature of his lesion. We have discussed this prior and we will do so more in great detail in the near future.
  2. Obtain articulated study models for a reference guide for his dental occlusion. This may be performed by his dentist.
  3. Surgery, left mandible:
    1. Partial mandibulectomy with removal of tooth #19 and tissue distal with maintenance of the mandibular condyle
    2. Autologous, cortical cancellous bone graft from the iliac crest to mandible with rigid bone plate fixation
    3. These procedures will be performed in a hospital operating room while the patient receives general anesthesia. An orthopedic surgeon will be consulted for harvesting of the bone graft.

Aspects of the details of the surgery will be discussed with the patient in the near future. Such topics will include the expected permanent anesthesia of the inferior alveolar nerve due to its ablation as well as aspects of reconstruction, limitation of function and need for long term rehabilitation. In the long term, dental implants maybe be used to replace the #19 and #18. Complex vestibuloplasty as well as other bone graft augmentation may be performed after the patient has healed over 1 year following these surgeries. He will need follow up care and the discussion of possible recurrence of the ameloblastoma cannot be ruled out.

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