Jane was fearful and in denial about her condition several months ago when she came to Kijabe. The swelling was present for 3 years and was hard to touch (intrabony swelling of the mandible). After clinically examining the size and extent of her swelling in her lower jaw and radiographic examination she seemed to have a dentigerous cyst. Dentigerous cysts are odontogenic cysts associated with the crown of an impacted tooth. From the radiograph you can see how the radiopacity it closely associate with the right third molar displaced to the inferior border of the mandible. Treatment requires surgery to enucliate the cyst wall, drainage of the cyst cavity, and eventual decompression of the mandible. Prognosis for this surgery is very good with full recovery of function and aesthetics.
We didn't see Jane for several months and it was unknown whether she was understandably fearful of the surgery or had not yet raised sufficient funds. She finally reemerged and we treated her in theatre with a general surgeon. After reflecting the gingival tissue and opening up the mandible into the lesion we were quite surprised. The lesion was full of blood and fibrous tissue instead of straw color cyst fluid as we had expected. The wall of lesion did not dissect smoothly off the margins of the mandible like a cyst lining but came apart in pieces. Furthermore the inside of her jaw continued to bleed forcing us to pack the inside of her mandible with 5 4x4 gauzes and leave the wound exposed.
Jane recovered quickly. Unfortunately her biopsy came back positive for Ameloblastoma (a more aggressive pathology). In retrospect examining the x-ray more carefully shows resorption of the 1st and 2nd molar root tips (perhaps indicating a more aggressive pathology) which might have led us to approach this differently. Her surgery although perhaps arresting lesion is non-definitive and she has high probability or reoccurence. Jane will require further more aggressive resection of her mandible. We have seen her once since, and hope she will agree to further treatment.
(Radiograph is inverted)