in the field of oral and maxillofacial surgery any tumour involving Infra temporal space is very much challanging. Clearance of ITF is a very much complicatded procedure.

1. Welcome to the morning
session
Good MorningGood Morning
Dr Mahbub Hussain
MS Phase B Resident
Oral And Maxillofacial Surgery
Department
BSMMU

2. A Pre Operative Case Presentation On Benign
Tumour of Left Side of Lower Jaw

3. Particulars of the patient
• Name: Shahnaj Akter
• Age: 19 years
• Sex : Female
• Address: Maizdee, Noakhali
• Adm Date: 24.03.18
• Bed No: FNP-29

4. Chief complaints
• Swelling on left side of face for 2 years.
• Mouth opening restricted for 6 month.
• Difficulty in mastication for same duration.

5. History of Present Illness
• According to the statement of the patient she was reasonably well 2
years back then she noticed a swelling on the left side of lower jaw.
The swelling was painless and increasing in size gradually and slowly.
From last 6 month she also noticed that her mouth opening was
decreasing and she felt difficulty during chewing food. Now she has
admitted into OMFS Department of BSMMU for better management.

6. Past Medical History
Dental History Nothing significant
Drug History
Habitual History
History of Immunization: Partially immunized
Family History : None of her family member suffering
from this kind of disease
Menstruation history : Regular
Socioeconomic Status : lower middle class

7. General Examination
• Appearance: Anxious
• Decubitus : On choice
• Body built :Average
• Anaemia
• Jaundice
• Oedema
• Dehydration Absent
• Cyanosis
• Clubbing
• Koilonichia

8. Systemic Examination:
• Cardiovascular System
• Respiratory System Reveals Normal
• Gastrointestinal System
• Nervous System
• Genitourinary System

9. Local Examination

10. Salient feature
Mrs. Shahnaz Akter 19 years old hailing from Maizdhi, Noakhali
presented here with the complaints of swelling on left side of face for 2
years, restricted mouth opening and difficulty during chewing food for
6 month. On examination there is a swelling on the left side of face
measuring 5X5 cm extending from zygomatic buttress to lower border
of mandible and 2 cm from angle of mouth to tragus, which is none
tender, hard in consistency, surface is smooth, overlying skin is free.
Intra orally mouth opening is 10 mm, oral mucosa reveals normal.
There is a palpable level 1B lymph node present which is single in
number tender oval shaped measuring 1 X .5 cm and free from
surrounding structures.

11. Provisional Diagnosis:
• Benign Jaw swelling of left side

12. Differential Diagnosis:
• Ossifying fibroma
• Fibrous dysplasia
• Osteoblastoma
• Ameloblastoma
• Cacifying epithelial odontogenic tumour

13. Investigations
• All investigation for G/A fitness was done and found within normal
limit.
• Orthopantomogram
• CT Scan.
• Incisional biopsy
• CT guided FNAC

14. OPG

15. CT Scan Axial View

16. CT Scan Coronal View

17. CT Guided FNAC

18. Treatment Plan
• Wide excision with 5 mm healthy margin.
• Reconstruction by vascularized myocutaneous fibula flap.

19. ITF Approaches
• Conley and Barbosa were the pioneer of ITF
• ITF approaches can be categorized as
Anterior approach
Transoral, Transpalatal , Transantral, Transmaxillary, Maxillary Swing,
Facial Translocation.
Lateral approach
Preauricular
Postauricular
Transzygometic
Inferior approach
Transmandibular

20. Transoral Transpalatal Transantral
Transmaxillary Maxillary swing

21. Facial Translocation Angle mandibulotomy
Double osteotomy of mandible

22. Thank
You