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.