This study examines the surgical management of ameloblastoma in 15 Taiwanese children between 1991-2004. The average patient age was 13.7 years. Most lesions were located in the mandible. Treatment methods included enucleation with peripheral ostectomy, decompression before enucleation, and segmental resection with bone grafting. The unicystic type lesions did not recur, while 3 of the multicystic cases recurred. Complications included numbness and facial deformity. The study concludes conservative surgery can achieve good results for ameloblastoma in children, and secondary surgery is effective for recurrence. Careful long-term follow-up is important.
ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.
Introduction
Epidemiology
Etiology
Manifestations
TNM staging
Squamous cell carcinoma is defined as malignant epithelial neoplasm exhibiting squamous differentiation as characterised by the formation of keratin and/or the presence of intercellular bridges.
( Pindborg et al, 1997).
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostoticii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformansc. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitisb. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibromab. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular typeii. Psammomatoid type
d. Gigantiform cementomas
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Ameloblastoma is benign slow-growing but locally invasive neoplasm of odontogenic origin. In 2005, the WHO has classified ameloblastomas into multi cystic, unicystic and peripheral subtypes. The clinical picture, radiographic findings and differential diagnosis are presented. Treatment of ameloblastomas is primarily surgical. There has been some debate regarding the most appropriate method for removing. These range from conservative to radical modes. Some authors advocate conservative approach and thought that ameloblastoma are essentially benign in nature and should be treated as such. However, this conservative approach result in recurrence rates of 55% to 90%of the cases. Currently, the standard of care for ameloblastoma includes en bloc resection with 1-2 combine margin and immediate bone reconstruction. Despite the medical nature of a surgical resection, it may actually involve less morbidity than extensive hard and soft tissue resection with associated extensive morbidity that may be warranted in case of recurrence following inadequate primary treatment.
ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.
Introduction
Epidemiology
Etiology
Manifestations
TNM staging
Squamous cell carcinoma is defined as malignant epithelial neoplasm exhibiting squamous differentiation as characterised by the formation of keratin and/or the presence of intercellular bridges.
( Pindborg et al, 1997).
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostoticii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformansc. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitisb. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibromab. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular typeii. Psammomatoid type
d. Gigantiform cementomas
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Ameloblastoma is benign slow-growing but locally invasive neoplasm of odontogenic origin. In 2005, the WHO has classified ameloblastomas into multi cystic, unicystic and peripheral subtypes. The clinical picture, radiographic findings and differential diagnosis are presented. Treatment of ameloblastomas is primarily surgical. There has been some debate regarding the most appropriate method for removing. These range from conservative to radical modes. Some authors advocate conservative approach and thought that ameloblastoma are essentially benign in nature and should be treated as such. However, this conservative approach result in recurrence rates of 55% to 90%of the cases. Currently, the standard of care for ameloblastoma includes en bloc resection with 1-2 combine margin and immediate bone reconstruction. Despite the medical nature of a surgical resection, it may actually involve less morbidity than extensive hard and soft tissue resection with associated extensive morbidity that may be warranted in case of recurrence following inadequate primary treatment.
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Megaprosthetic replacement of knee in a young boy of 14 yearsApollo Hospitals
Now a days, Total Knee Replacement (TKR) is a common for elderly patients but is an uncommon procedure in young individuals. Recently, limb conservation surgery for malignant bone tumours like osteosarcoma around the knee has become a common indication for TKR in young. We report, here a histologically confirmed osteosarcoma in right
proximal tibia of a 14-year-old boy who was managed successfully by limb salvage surgery using Global Modular Replacement System (GMRS, Stryker).
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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3. Objective
The purpose of this study was to
report experience in the treatment
of ameloblastoma in Taiwanese
children and to discuss the treatment
regimen
4. Study design
Fifteen patients, all younger than 18
years of age, with a diagnosis of
ameloblastoma in our department
between January 1991 and December
2004 were selected for study. Data
included sex, age at surgery, tumor
type, size and site of lesion, primary
surgical methods, use of adjuvant
therapy, complications, recurrences,
and course of follow-up.
5. Results
Ages ranged from 9 to 17 (average was
13.7 years). Nine were male, 6 were
female; the sex ratio was 1.5:1.
Fourteen lesions were in the mandible (1 in
the symphysis, 13 in the mandibular posterior
area) and only 1 was in the maxilla. The size
of the lesions ranged from 4*2.5 cm to 8*8
cm. Clinical typing included 8 unicystic type,
3 multicystic type, and 4 solid types. Of the
histologic types, 5 were plexiform, 3 were
mixed type, and 3 were acanthomatous type.
Complications included numbness of the
lower lip and contour defect of the face.
Three cases (20%) were recurrent, and 1
patient had 2 recurrences.
6. Conclusions
Good results can be achieved in the
treatment of ameloblastoma in
children using conservative
surgery.
In the event of recurrence, a second
surgery can be successful. Patient
compliance and careful follow-up are
important.
(Oral Surgery Oral Medicine Oral
Pathology Oral Radiology
Endodontology 2007;104:478-85)
7. Ameloblastoma is the most common
aggressive benign odontogenic tumor of
the jaws.
The tumor is often asymptomatic,
presenting as a slowly enlarging facial
swelling or an incidental finding on a
radiograph. The physical presence of the
tumor may cause symptoms such as
pain, malocclusion, loosening of teeth, or
ulceration. Ameloblastoma is a locally
destructive tumor with a propensity for
recurrence if not entirely excised.
8. A few cases of malignant change with
distant metastasis have been reported
in the literature.
It occurs in all age groups but the
lesion is most commonly diagnosed in
the third and fourth decades.
The tumor is considered a rarity in the
young, but the tumor grows slowly and
probably starts to develop in childhood
9. The treatment for ameloblastoma is still
controversial and poses some special
problems in children.
Because of growth of the jaw, the different
incidence,behavior, and prognosis of the
tumor make the surgical consideration
different from adults. Some reports have
encouraged aggressive resection for
ameloblastoma in children, and some
studies showed simple curettage had
good results.
10. The aim of this study was to review a
series of ameloblastoma in Taiwanese
children, and to present our
experience of surgical treatment in this
pediatric group. We hope this report
may contribute to further meta-
analysis and develop a more rational
surgical protocol for ameloblastoma in
children.
11. PATIENTS AND MATERIALS
Of 223 patients with ameloblastoma, 15
(6.8%) were 18 years or younger
when presenting to our department,
and surgery was performed during the
period January1991 to December
2004. We reviewed patient age and
sex, anatomical distribution and size
of the lesions, histologic types, clinical
types, surgical methods, recurrence,
complications, and outcome.
12. All patients underwent incisional biopsy
before the surgery. Three surgical
techniques were used:
(1) Enucleation with peripheral
ostectomy,
(2) Decompression before enucleation
with peripheral ostectomy, and
(3) Segmental resection with immediate
iliac bone graft.
13. Enucleation with peripheral
ostectomy
Enucleation with peripheral ostectomy was
performed from an intraoral approach; the
lesion being removed along the junction of
the lesion and bone, and then peripheral
bone was carefully trimmed off for 3 to 5 mm
with a large round bone burr, including any
septa for multicystic and solid types. The
wound was packed open for 2 weeks, then
the obturator was constructed and the patient
instructed to irrigate the cavity with boiled
water or normal saline. The wound was then
allowed to heal secondarily or the cavity was
filled with artificial bone substitutes and
primary closure.
14. Decompression before enucleation with
peripheral ostectomy
Decompression before enucleation with
peripheral ostectomy was used when the
lesion was found to be cystlike on biopsy, and
the pathology report confirmed
ameloblastoma. After 1 week, when the
patient returned for the biopsy report, the
benefits and risks of this plan would be
discussed; if the patient understood the plan
and agreed to comply, decompression would
be used as a first measure. Under local
anesthesia, a mucoperiosteal flap would be
reflected to expose the lesion, and a bony
window made of adequate size to allow
opening of every loculation.
15. A decompression plug would be inserted (Fig. 1),
and the wound closed.
Patients were taught to irrigate the cavity through
the hole in the plug after each meal. Follow-up
was arranged monthly with radiographic follow-
up at 3 months to evaluate change and bony
regeneration.
From 6 to 12 months later, enucleation with
peripheral ostectomy would be performed under
general anesthesia.
Postoperative care was similar to that discussed in
the previous section “Enucleation with peripheral
ostectomy.”
16.
17.
18. Segmental resection with immediate iliac
bone graft
In segmental resection with immediate iliac
bone graft, the extraoral resection was made
through the mandible with a 1-cm margin of
healthy bone. The reconstruction plate and
iliac bone graft were placed immediately for 6
weeks of intermaxillary fixation.
This technique was used for all solid-type and
multicystic lesions with involvement of the
lower border or posterior border of the
mandible, and when patients and parents
chose radical surgery to decrease the chance
of recurrence
19. RESULTS
Of the 15 patients, 9 were male and 6 were
female, a ratio of 1.5:1.
The mean age was 13.7 years (range from 9 to
17 years). The angle region (body-angleramus)
was the most common site (10 of 15, or 66.6%),
followed by
Mandibular body (3 of 15, or 20%),
Symphysis(1 of 15, 6.7%),
Maxilla (1 of 15, 6.7%). The clinical types were
as follows: 8 of 15 were unicystic (53.3%), 3
were multicystic (20%), and 4 were solid tumors
(26.7%). Pathologic typing showed 5 to be
plexiform, 3 mixed, and 3 were acanthomatous
type. Sizes of the lesions ranged from 4*2 cm to
8*8 cm.
(Table I).
20.
21. Treatments were direct enucleation and
peripheral ostectomy for 5 cases (3 unicystic,
1 multicystic, and 1 solid type);
decompression before enucleation with
peripheral ostectomy for 6 cases (5 unicystic
type and 1 multicystic type); and segmental
resection and iliac bone graft for 4 cases (3
solid and 1 multicystic type, which had
decompression surgery first, but did not
respond to the treatment in 3 months and it
was decided to initiate segmental resection
and bone graft).
No unicystic type recurred
22. Two of 3 multicystic-type cases were
recurrent. Of the 4 patients with solid
type, 1 treated with enucleation and
bone trimming was recurrent and then
had segmental resection and bone graft
6 years later (when the patient was 19
years old), and no recurrence thereafter.
Another 3 solid types with segmental
sectioning and bone grafts were not
recurrent. In total, 3 cases had 4
recurrences
23. Radiographic findings showed 10
monolocular lesions and 5 multilocular
radiolucent lesions. There were 2 solid-
type lesions presented in monolocular
and multilocular image groups. The
follow-up period was from 2 years to 17
years. Complications, including mild
facial deformity and permanent lip
numbness were noted in all patients with
segmental resection and bone grafts.
Only 2 cases had permanent lip
numbness after enucleation and
peripheral ostectomy.
24. DISCUSSION
Ameloblastoma is uncommon in the pediatric
population,with only 8.7% to 15% of all ameloblastomas
in Western countries. The Asian and African reports
show a higher percentage, ranging from 14.6% to
25%.3,10 Because ameloblastoma is uncommon, only
a few surgeons have much experience in treating this
lesion. The extent of surgical excision of mandibular
ameloblastoma has been the subject of debate for
many years. Many recent reports have warned of high
recurrence rates (75%-90%) with conservative
treatment, compared with recurrence rates of 15% to
25% after radical surgery.
One report shows a high success rate of tumor
resection, reconstruction, and rehabilitation for pediatric
patients, and declared that the current standard of care
is en bloc resection with wide margins to prevent
recurrence, with staged reconstruction with bone grafts
and an implant-supported prosthesis.
25. Ameloblastoma is usually classified into 3 types:
solid or multicystic, unicystic, and peripheral. The
cystic type of ameloblastoma is predominant in young
patients. The multicystic and solid lesions are sometimes
considered as one type because of similar behavior,
with a locally invasive tumor and high recurrence
rate, and are usually excised radically.
We would rather
classify ameloblastoma into 4 clinical types for pediatric
patients: solid, multicystic, unicystic, and peripheral.
We suggest the multicystic type should be treated
conservatively as different lesions, especially for children.
26. For multicystic ameloblastoma, many
reports suggest radical surgery where
the buccal and lingual bone plates are
sacrificed along with their periosteum
and any suspicious surrounding soft
tissue being removed. 3 patients with
multicystic type were treated by 3
different methods. The first patient, a 12-
year-old boy (Fig. 2), had decompression
treatment for 6 months and then
accepted enucleation and peripheral
27.
28.
29. The lesion recurred 3 years later (Fig.
4), and he had a secondary operation
with enucleation and bone trimming.
Four years after the second surgery
(Fig. 5),
30.
31.
32. Four years after the second surgery (Fig. 5),
it recurred again and he had a third operation
(same procedures), and was monitored for
another 10 years (Fig. 6), for a total of 17
years of follow-up. No recurrence has been
noted so far. The first operation was
performed under general anesthesia; the
second and third operations were done under
local anesthesia.
The patient and his parents were satisfied
with the treatment, and there was no lip
numbness, a limited number of teeth were
removed, and there was no functional
disturbance or esthetic problem.