2.3 Surgical Intervention
Given the patient’s age, noticeable size of the lesion, its invasive and
recurrent characteristics, accompanied with buccal cortex expansion and
destruction, enucleation and curettage and peripheral ostectomy
accompanied with concomitant burnishing of teeth roots was planned.
After obtaining a written informed consent form from the patient and
informing her regarding the poor prognosis of the remaining affected
teeth, the surgery was performed under local anesthesia. Surgical
procedure incorporated bilateral mental nerve anesthesia, followed by a
full periosteal flap elevation with great vigilance in exposing and
preserving bilateral mental nerves and subsequent excision of the lesion
mass with curette and periosteal elevator in a piece by piece manner
with extreme caution to preserve teeth roots (Figures 5, 6). Teeth roots
were then cautiously burnished. Afterwards, peripheral ostectomy with a
wide margin of 2-8 mm was conducted and the flap was reapproximated and
sutured (Figures 7, 8).
The excised specimen measuring at 2.5 x 2 x 1.5 cm accompanied with six
irregular fragments of the same tissue and small bone particles
aggregating to 2 x 1 x 1 cm was then placed in formalin and sent to
pathology laboratory which further confirmed the definitive diagnosis of
odontogenic myxoma.
The patient was informed of the recurrence tendency of the lesion and
was advised for annual follow-ups for at least 5 years.