Gerald S. Fine, D.D.S.
Oral and Maxillofacial Surgery
This past January I saw a 52 year old female nurse who referred herself to my office upon the development of numbness and facial swelling in the mandibular left canine-first bicuspid area. Her swelling had begun only the previous day; but was significant. Her concern was heightened by the rapidity with which the swelling had developed and by the numbness associated with the swelling.
My examination was significant for facial swelling of the soft tissue as well as an expansion of the buccal plate of bone and significant mobility of the mandibular left canine and first bicuspid teeth. The mandibular left second bicuspid tooth demonstrated a recently placed amalgam restoration, The panoramic film obtained that day outlined a 2.0 cm X 4.0 cm radioluscency. My patient's family dentist had retired, selling his practice and my patient continued with the "new" family dentist on a regular basis for the past four years for routine treatment. I asked her to obtain her prior dental radiographs to help determine the possible duration as well as aggressiveness of this lesion. These radiographs I was told would be of no help as her "new" dentist had taken "bite wing" films only.
A high resolution CAT scan of the mandible revealed a 2.0 X 3.0 X 4.0 cm expansile cyst involving the medial aspect of the inferior alveolar nerve canal and the left mental foramen. The patient was treated at the Newton-Wellesley Hospital and the cyst removed. The pathology diagnosis was: Cyst of the mandible: Ameloblastoma, Unicystic, Mural type.
Subsequently, my patient was operated on again. Her second surgical procedure was extensive and included the removal of the teeth from the mandibular left first molar to the mandibular right central incisor. The lesion was enucleated and the bed of the lesion was cryosurgically treated. The area was then bone grafted with compacted marrow from the patient's left iliac crest. A closed reduction with intermaxillary fixation was lastly performed.
Early and prompt diagnosis is critical in the treatment of an ameloblastoma. X-rays other than bite wing films would have revealed the development of the lesion and reduced the extensiveness of treatment. If it is not possible to obtain adequate periapical films of a particular area a panoramic film should be obtained.
Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery