19 yr old male patient, h/o swelling on the right side of the face from past 3 months. Opg attached. What is your diagnosis? What would be the treatment plan.



This is what I have done. Eneucleation followed by Extraction and Marsupialization
The above pic is after 1 year post Operative. I have been following this case. As a first line of treatment I am going with conservative approach.

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A dentigerous cyst or follicular cyst -- an odontogenic cyst - of developmental origin - associated with the crown of an unerupted tooth.

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Well interpretating this opg, A large radiolucency seen and it is growing anteroposteriorly having unilocular cystic appearance also (soap bubble appearance) suggestive of ameloblastoma. Also root resorption is seen and since the swelling is not allowing the tooth to erupt, a dentigerous cyst can be associated and if turns malignant; it can give rise to 3 lesions- ameloblastoma, squamous cell carcinoma and mucoepidermoid carcinoma (central type). Treatment modality- En bloc resection is done for ameloblastoma. And for dentigerous cyst- Small cysts- marsupilisation Large cyst- surgical excision with removal of the margins.
Isnt it reverse ?small lesion excision and alrge lesion marsuplisation. Plz clear my doubt

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Opg resembles to be dentigerous cyst differentiated into ameloblastoma, a benign aggressive tumour. Treatment involves surgical resection followed by reconstruction of mandible by plating
@Dr. Chaitanya Divi please find a case attached regarding the use OF monoclonal stem cell,case was 21/f ,with swelling in the left lower jaw, diagnosed as Ameloblastoma
There is an initial impression of follicular or dentigerous cyst. But it carries a high potential for Ameloblastic transformation, even after enucleation.
Let's discuss, who agrees with aggressive treatment of resection and reconstruction or who goes for conservative therapy?
Given the biopsy report as dentigerous cyst turning into ameloblastoma, I don't think conservative treatment would help rather may lead to recurrence. So I would support aggressive treatment. Also given the Age of patient resection and reconstruction should give good and long lasting results. Just my opinion. Thank you

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As a surgical oncologist I would prefer to do aggressive resection and free fibular flap reconstruction. Others can opine
Sir, do you agree with the aggressive approach for a young patient with a lesion that is rarely metastatic, hampering the quality of life? I know that the recurrence rates of an ameloblastoma are high but considering the age factor I had approached the lesion with a conservative approach and got a detailed written consent from the patient with all possible risks and complications

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malignant transformation of dentigerous cyst!!!
What do you mean by Malignant transformation? Then the lesion is turning into?

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precise diagnosis of the type of ameloblastoma via histopathological report is needed as few types of ameloblastomas have higher recurrence rates...If proved to be so, resection of the tumor with healthy margins followed by reconstruction is the proposed treatment plan..conservative management will entail routine periodic follow-ups to check bone formation.Also vitality of 46 & 47 is to be done.
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