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Medical Forum / General / Dentistry / December 2005amelioblastoma
My DDS removed a lesion that has been biopsied as an amelioblastoma. It penetrated the bone from inside of the jaw to outside. Biopsy did not include any normal bone/tissue so it is assumed that excision did not get back to "good" bone. DDS is going to review actual cell sample as there is a suspicion that it may be aggressive since actual lesion occurred in about a 2 month time period in a cycst like formation that then extended into a flattened formation that extended frontally to front teeth and down to botton of jaw. I read a posting that stated that left untreated, a person's ability to consume food would eventually fail and the person would effectively starve ( basically the tumor invades the entire oral cavity....frightening prospect). But my questions are more mundane. Anybody successful getting insurance to pay??? My DDS said, worse case basis, the extraction of the two teeth above the blastoma, the curettage, the bone implant and hosptialization would run $10k to 15k. My employer's (I'am disabled but still qualify under the employer's plan) self-funded plan, admisitered by CIGNA, excludes oral surgery for teeth and periodontium except for excision of epulis and extraction of unerupted impacted tooth. I get the feel from the DDS that we submitted it to the insurer and if it gets paid, it gets paid; if it doesn't than I bill you (i.e., takes himself out of the reimbursement detail.) I guess basic question is, is this a periodontium issue? I tried web resources for definition and I simply got lost in the detail. From what the DDS assistant indicated, the initial excision would not qualify as an epulis nor would any future surgery. So, I'm back to the financing question. I qualify for Medicare Part B but have not enrolled since I have an employer plan. Would Medicare cover? I know I should be more concerned with the health aspect of it, but $15k is not an easy expenditure. My (then) 18 year old son had an right maxillary ameloblastoma 2 1/2 years ago. His surgery was done by an oral surgeon and involved removal of 4 teeth, 1/3rd of his upper jaw bone, about 1/4th of the roof of his mouth and sinus bone & some cheek tissue. You can search "ameloblastoma" on this group and find more details if you wish. The reason I am responding to you is to let you know that our medical insurance covered everything - even though we don't have any dental coverage. I believe an ameloblastoma is considered a medical condition rather than a dental condition. We are in the process right now of evaluating my son for possible jaw reconstruction and our medical insurance company has given verbal approval for the CT scan and skull model that are necessary to determine the next step and they give us no reason to doubt that they will pay for the surgery, prothesis and implants to restore his mouth to near-normal functioning. Due to the aggressive nature of ameloblastomas, I would be very wary of having a regular dentist treat this. Is your DDS referring you out to a surgeon or is he planning to do it (that's what your post sounded like to me)? It is necessary to remove the tumor and 1 cm of healthy tissue to insure clean margins. If any tumor cells remain, there is a great chance of the tumor returning. I'm part of an ameloblastoma support group online and there are a number of people on there that had their tumors recur 10 to 20 years after initial removal due to inadequately aggressive treatment when they were first diagnosed. Of course, more is known about ameloblastomas now than then when it seems treatment involved tumor removal and scraping the bone but not removing it. I hope you get good news about the financial end of this - the disease is upsetting enough without having to worry about how to pay for the treatment. Good luck and please let us know how you make out. >My (then) 18 year old son had an right maxillary ameloblastoma 2 1/2 >years ago. His surgery was done by an oral surgeon and involved [quoted text clipped - 28 lines] >is upsetting enough without having to worry about how to pay for the >treatment. Good luck and please let us know how you make out. I'm sorry for the pain that your son must be going thru. My problem seems to be in the early stages. To answer your question, my DDS will be doing the surgery. He is also an oral surgeon. I'm a newbie in this area so, to me an oral surgeon is the person who shouuld do it? Who did your son's? Is there another specialty surgeon for this? My regular health insurance plan does provide coverage for oral surgery but limited to TMJ and the other procedures (epulis and impacted unerupted teeth). The insurance benefit plan seems to be very limited in this area. Could you give me the address for the support group, or is that limited to individuals who have (versus going to have) extensive surgery? Thank you for your response. >>My (then) 18 year old son had an right maxillary ameloblastoma 2 1/2 >>years ago. His surgery was done by an oral surgeon and involved [quoted text clipped - 39 lines] > group, or is that limited to individuals who have (versus going to have) > extensive surgery? Thank you for your response. An oral and maxillofacial surgeon is the appropriate person for treating your condition. I cannot speak to the details of your insurance, but I wouldn't worry too much about few oral surgical procedures listed on your policy. This is SURGERY, and while it is a normal part of oral surgical practice, as an inpatient procedure it should be covered, assuming you have a good hospitalization/major medical coverage. Good luck, Steve Below is the url of the ameloblastoma group. It is open to anyone who is affected - or caring for someone who is affected by the disorder. If you join the group (it is free), you can go into the messages and learn a lot. Feel free to post questions there too - it is a small group (73 members) but then this is a rare condition so there are not that many people who have it. There is at least one physician in the group who answers questions from time to time. http://health.groups.yahoo.com/group/ameloblastoma/ >From the webpage..."Welcome to the Global Health Network's international support community for people affected by "Ameloblastoma." This group is open to anyone interested in making friends, sharing information and support with others affected by this disorder." In answer your other question - My son's surgery was done by a local oral-maxillofacial surgeon. His reconstructive surgery is being co-ordinated by a prosthodontist and an oral-maxillofacial surgeon who are affliated with the University of Illinois at Chicago. > My DDS removed a lesion that has been biopsied as an amelioblastoma. It > penetrated the bone from inside of the jaw to outside. Biopsy did not [quoted text clipped - 22 lines] > Would Medicare cover? I know I should be more concerned with the health > aspect of it, but $15k is not an easy expenditure. If this is being done on an in-patient basis, it almost certainly will be covered under any hospitalization-major medical coverage you have, rather than dental. This is definitely NOT periodontal. Speak to the benefits manager for your employer and make sure you do whatever you need to do preoperatively, esp. if your surgeon cannot guide you here. Good luck, Steve >> My DDS removed a lesion that has been biopsied as an amelioblastoma. It >> penetrated the bone from inside of the jaw to outside. Biopsy did not [quoted text clipped - 8 lines] >your employer and make sure you do whatever you need to do >preoperatively, esp. if your surgeon cannot guide you here. Your right about the hospital part but that , in contract, is limited to bed and board plus and necesary services (basically operating room) or outpatient facility. Yes, the hospital piece will be covered. But , and I really don't know, assume the hospital piece will not be the largest share of the expense. The sugeon's fee will probably be the larger share followed by the anesthesiologist. I'm sure the medical plan will carve out all the services that they can. I'm generally pessimistic when it comes to our plan. My initial inquiries in to Medicare Part B is that they indeed do not consider such an operation as dental and therefore seemingly does provide coverage for surgery services of all physicians and hospital. But I'm not sure whether the DDS accepts Medicare patients. Enrolling in Part B shouldn't pose a barrier for me. Thank you Basically, ameloblastomas are benign although they can be lethal through extensive growth and closing off the airway. Joel M. Eichen DDS > My DDS removed a lesion that has been biopsied as an amelioblastoma. It > penetrated the bone from inside of the jaw to outside. Biopsy did not [quoted text clipped - 22 lines] > Would Medicare cover? I know I should be more concerned with the health > aspect of it, but $15k is not an easy expenditure. >Basically, ameloblastomas are benign although >they can be lethal through extensive growth and >closing off the airway. > >Joel M. Eichen DDS I do not consider a recurrent growth to be 'benign' in any way. Ameloblastoma is diagnosed often enough to not be considered 'rare' in this and past decades. Have been in contact with pdurant privately about Lukes' surgeries and reconstructions to know about the progress of a very difficult long term treatment, surgeries, and reconstructions. JME you need to 'back off' on this case, and keep your quick hip-shot bullshit answers off of this case. How can you ever consider any tumor to be lethal and benign at the same time ? Your flippant comments about treating a rare, but real, abnormal cellular growth disgusts and disturbs me. Ameloblastoma is a very difficult pathology to treat. I repeat: Your statments disgusts and disturb me JME / -- Whamatus Bemoana wubbabubbazG@RBAGE at yahoo dot com >>Basically, ameloblastomas are benign although >>they can be lethal through extensive growth and [quoted text clipped - 3 lines] > >I do not consider a recurrent growth to be 'benign' in any way. In the way that it isn't malignant and doesn't metastasize it is benign. That's medical terminology and something you'll have to get used to. If I were the patient I would be really pleased to hear that. It means he doesn't have to worry about it suddenly appearing years later in the lungs, liver or bones. I don't particularly get along with Joel either but this time he is right. The tumour is benign but can kill by virtue of its position. If the patient gets prompt treatment the prognosis is good. Ann >Ameloblastoma is diagnosed often enough to not be considered >'rare' in this and past decades. [quoted text clipped - 17 lines] > >/ > In the way that it isn't malignant and doesn't metastasize it is > benign. That's medical terminology and something you'll have to get > used to. If I were the patient I would be really pleased to hear > that. It means he doesn't have to worry about it suddenly appearing > years later in the lungs, liver or bones. But it _can_ recurr and is often missed that way. I don't think we have markers for ameloblastoma proteins like we do for some cancers. SP  SignatureTake out the TRAASH to reply >> In the way that it isn't malignant and doesn't metastasize it is >> benign. That's medical terminology and something you'll have to get [quoted text clipped - 4 lines] >But it _can_ recurr and is often missed that way. I don't think we have >markers for ameloblastoma proteins like we do for some cancers. Yes it can recur at the same site. As you said in another post it needs to be dealt with by the appropriate department who will ensure that it is removed with clear margins so minimising the possibility of recurrence. I would suggest that proper person isn't a dentist. Ann > >> In the way that it isn't malignant and doesn't metastasize it is > >> benign. That's medical terminology and something you'll have to get [quoted text clipped - 13 lines] > > Ann I would think you're right, unless that dentist in operating in the correct environment, with a Path department right close by, and that DDS/DMD knows where his towel is. I am not one of those dentists, and even if I was: how many of these things would I normally see in my career? A couple at best. SP SignatureTake out the TRAASH to reply > I would think you're right, unless that dentist in operating in the > correct environment, with a Path department right close by, and that > DDS/DMD knows where his towel is. I am not one of those dentists, and > even if I was: how many of these things would I normally see in my > career? A couple at best. > SP We've all seen those textbook pictures of ameloblastomas that take off half a person's face, but these are rarities. What circumstance and extension would make you think a proficient OMFS should throw in the towel? Steve > > I would think you're right, unless that dentist in operating in the > > correct environment, with a Path department right close by, and that [quoted text clipped - 10 lines] > > Steve 'Think I was unclear. 'Knowing where one's towel is' is HitchHikers' Guide to the Galaxy talk for being on top of things and knowing what one is doing. That is what the OMFS would be. Maybe they would still do an incisional biopsy in office for diagnostics purposes, but I can't see that. I think that if at all possible, and the lesion looks doubtful, they should be doing their excisions in the hospital or wherever they can get a Pathologists' evaluation of some fresh slides while the patient is still anesthetized. Maybe that is Utopic thinking on my part, but that is why I hardly ever do any soft tissue excision; I send it to the OMFS, who can deal with the eventualities responsibly. I should add that any periapical or lateral lucency seen on the radio gets scooped out after the extraction. I put 'em in an anesthesia carpule with formaldehyde/H2O 1:9 and take 'em up to the hospital myself. They have always come back benign inflammatory or organized cystic tissue (knock wood) with detailed descriptions, but no cancers or whatever. I don't tell the patient I'm doing this, because being a low priority request, it can take time to get the results back. I don't want the patient walking on egg cartons expecting the worst. I should also add that the Bullshit Biolase-ists were encouraging us to do as much soft tissue excision as we could. What is a general dentist going to do if the Histology examiner writes back: 'no clear margins' ? No thanks When would the OMFS throw in the towel? Perhaps if the lesion is getting up towards the brain, or down towards the larynx, they might want to call in the Plastics men or the ENT's. The point is, I don't think _we_ should be running around with Guillotines cutting out things unless we are 100 percent prepared to deal with the eventualities. Would really like to get DK's view on this... SP SignatureTake out the TRAASH to reply >>>I would think you're right, unless that dentist in operating in the >>>correct environment, with a Path department right close by, and that [quoted text clipped - 47 lines] > > SP Thanks for the clarification. Of course, ameloblastomas of any size have such a characteristic appearance on x-ray that I'm guessing that these get wide local excision and not an incisional biopsy. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Thanks for the clarification. > Of course, ameloblastomas of any size have such a characteristic > appearance on x-ray that I'm guessing that these get wide local excision > and not an incisional biopsy. > > Steve Then why do you think the OP's dentist did one? Unless I'm missing something. Thanks SP SignatureTake out the TRAASH to reply > > Thanks for the clarification. > > Of course, ameloblastomas of any size have such a characteristic [quoted text clipped - 7 lines] > Thanks > SP Interesting question. TW >> Thanks for the clarification. >> Of course, ameloblastomas of any size have such a characteristic [quoted text clipped - 7 lines] > Thanks > SP I could only speculate. I don't remember the OP stating that this was in conjunction with an extraction, but could be some soft tissue curetted from an extraction socket. Alternatively, it might not have been intended as an incisional biopsy per se, but as an excision that wound up having dirty margins. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > >> Thanks for the clarification. > >> Of course, ameloblastomas of any size have such a characteristic [quoted text clipped - 15 lines] > > Steve In other words, it may have come up as a matter of concern during a "routine" office treatment? TW >>>> Thanks for the clarification. >>>> Of course, ameloblastomas of any size have such a characteristic [quoted text clipped - 20 lines] > > TW Many of them do. You hope you catch them early, and before they have symptoms. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > >>>> Thanks for the clarification. > >>>> Of course, ameloblastomas of any size have such a characteristic [quoted text clipped - 25 lines] > > Steve Yes... early. I know someone who ended up with an advanced problem that went undetected for years. The outcome, fortunately, was satisfactory to the patient, but certainly a most unfortunate event for the man. TW >> > I would think you're right, unless that dentist in operating in the >> > correct environment, with a Path department right close by, and that [quoted text clipped - 47 lines] > >SP SB mentioned the histology and clinical behaviour resembling a BCCA and he is correct. Both can be deadly if allowed to. I have excised many through residency & private practice. Some were primaries and some were recurrences due to less aggressive management. I have never seen an ameloblastoma metastisize but I have seen them recurr in local soft tissue. Proper tumor hygeine is paramount and I wait and track with serial films for many, many months before reconstructing. Follow-ups are a must and I stay married to the patient for years. Fortunately I have never had to throw in the towel and the closest I would probably get is dual surgeons with another needed specialty. Dave > SB mentioned the histology and clinical behaviour resembling a BCCA > and he is correct. Both can be deadly if allowed to. I have excised [quoted text clipped - 8 lines] > > Dave 'K... Thanks for the eplanation. SP SignatureTake out the TRAASH to reply >> >> In the way that it isn't malignant and doesn't metastasize it is >> >> benign. That's medical terminology and something you'll have to get [quoted text clipped - 8 lines] >career? A couple at best. >SP Re: "a couple at best." Which leads me to the following question. Is a radiological translucency only associated with an ameloblastoma? Is that the only diagnosis for a firm, non-tender, fleshy growth just below the bottom of the teeth? My question does not stem from an issue of medical liability but rather from medical ability. Given the limited number of times a DDS encounters this tumor, could it (translucency) be confused with another diagnosis. >>> >> In the way that it isn't malignant and doesn't metastasize it is >>> >> benign. That's medical terminology and something you'll have to get [quoted text clipped - 16 lines] >encounters this tumor, could it (translucency) be confused with another >diagnosis. Clinical diagnosis of a leison like this should be confirmed by biopsy and microscopic examination. Dave King is much better suited to answer your question. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>>>In the way that it isn't malignant and doesn't metastasize it is >>>>>benign. That's medical terminology and something you'll have to get [quoted text clipped - 17 lines] > encounters this tumor, could it (translucency) be confused with another > diagnosis. Ameloblastoma has a rather characteristic appearance on x-ray, and if of any significant size it is unlikely to be confused with any radically different kind of lesion (though there are a few closely-related tumors that look similar). But considering you've already had the diagnosis confirmed by biopsy, this shouldn't concern you. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Given the limited number of times a DDS > encounters this tumor, could it (translucency) be confused with another > diagnosis. I think Meyer S Leonard (Oral Surgeon and educator) has answered this question best: the general dentist gets to become expert in the *normal*. *Normal* radoilucencies (the vast majority that we see) are associated with tooth pathology, and not tumors of the ameloblastic type. An over large lucency, or an oddly shaped one, or one not immediately associated with a tooth, or one with ragged boarders, should alert the dentist to the *abnormality* of what he/she is seeing. If that dentist has competence in oral pathology, s/he can pre-diagnose (or at lesast limit the choices). There are tumors, such as the unicystic ameloblastoma, that can mimic periapical (tooth) pathology, but their behavior is not the same as that of periapical pathology. Also, any diagnosis of a tissue tumor should be biopsied for comfirmation, and as I have said, _I_ would prefer that the Oral Surgeon do that in a hospital setting, if possible, so that the OS can treat immediately and aggressively if the histology exam reveals a nasty tumor. Therefore, most dentists who are paying attention, would twigg to the fact that this is not a normal mouth condition and that the case should be gotten to the proper competencies. The same goes with conditions that don't respond to treatment. I hope this is clearer: what I'm trying to say is that you don't need to doubt and cross examine your dentist if s/he says that something is or isn't right; most will call in the big guns when needed. I will also add that, IMO, this is far more likely to happen in a medical exam setting, where the Mad Dogs are more likely to treat with an eye to statistical probablility and what is most often seen than we are. Without going into the gory details, IMO, this is why my sister is now dead. Cheers SP SignatureTake out the TRAASH to reply > Yes it can recur at the same site. As you said in another post it > needs to be dealt with by the appropriate department who will ensure [quoted text clipped - 4 lines] > > Ann While I'm sure that head/neck surgeons have treated many ameloblastomas, to my knowledge the OMFS is generally the first-line surgeon. We are not dealing with a lesion with a large incidence of lymphatic spread (though it is not unknown). Furthermore, many of these lesions are reconstructed at the same time. I personally would want an OMFS to do this if it were my child. Steve > While I'm sure that head/neck surgeons have treated many > ameloblastomas, to my knowledge the OMFS is generally the first-line [quoted text clipped - 4 lines] > > Steve Ditto, and very well said. SP SignatureTake out the TRAASH to reply >> Yes it can recur at the same site. As you said in another post it >> needs to be dealt with by the appropriate department who will ensure [quoted text clipped - 11 lines] >lesions are reconstructed at the same time. I personally would want an >OMFS to do this if it were my child. Probably a language difference. Dentist to me in the UK means something different from what it does to you I suspect. I should have remembered that. Ann >I would suggest that proper person isn't a dentist. > >Ann An Oral MaxilloFacial Surgeon is a dentist first. Then became a specialist. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>I would suggest that proper person isn't a dentist. >> >>Ann > >An Oral MaxilloFacial Surgeon is a dentist first. >Then became a specialist. Oh you can speak civilly. I did wonder. Apologies that I wasn't more distinct. I don't know US terminology. We wouldn't generally call a Maxillofacial surgeon a dentist here. Ann > >> In the way that it isn't malignant and doesn't metastasize it is > >> benign. That's medical terminology and something you'll have to get [quoted text clipped - 13 lines] > > Ann "If I were the patient I would be really pleased to hear that. It means he doesn't have to worry about it suddenly appearing years later in the lungs, liver or bones." Ann, Very good. I was thinking the same thing. It also means that there will be no chemotherapy following surgery! Chemotherapy is sometimes recommended following surgical removal of malignant neoplasms, such as those that show lymph node infiltration. And chemotherapy is not a great adjunct to anticipate... if you know what I mean. -Sue >>>Basically, ameloblastomas are benign although >>>they can be lethal through extensive growth and [quoted text clipped - 7 lines] >benign. That's medical terminology and something you'll have to get >used to. Duh ! Where did you get your dental degree ? Sears & Roebuck ? > If I were the patient I would be really pleased to hear >that. It means he doesn't have to worry about it suddenly appearing [quoted text clipped - 27 lines] >> >>/ -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Duh ! > Where did you get your dental degree ? Sears & Roebuck ? Obviously, the use of the word "malignant" vs "benign" is fraught with imprecision. I've never heard a satisfactory explanation for why a basal cell tumor of skin is classified a carcinoma but ameloblastoma is not. The cell of origin and location is different, but their clinical behaviors are very similar. And of course, there are rare instances where either has been known to metastasize. I've heard smart doctors say that the use of the word "benign" in connection with a brain tumor is never appropriate. Steve >>If I were the patient I would be really pleased to hear >>that. It means he doesn't have to worry about it suddenly appearing [quoted text clipped - 33 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >>>>Basically, ameloblastomas are benign although >>>>they can be lethal through extensive growth and [quoted text clipped - 10 lines] >Duh ! >Where did you get your dental degree ? Sears & Roebuck ? I don't know what Sears & Roebucks is so your attempt at a put down has backfired. Do you think that dentists have a monopoly on medical education? You seem to be a tad egotistical. Ann >> If I were the patient I would be really pleased to hear >>that. It means he doesn't have to worry about it suddenly appearing [quoted text clipped - 27 lines] >>> >>>/ >>Duh ! >>Where did you get your dental degree ? Sears & Roebuck ? [quoted text clipped - 4 lines] > >Ann And you seem to be a bit of a dim bulb. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>Duh ! >>>Where did you get your dental degree ? Sears & Roebuck ? [quoted text clipped - 6 lines] > >And you seem to be a bit of a dim bulb. IKYABWAI The older medical books and some newer one do not even have amelioblastoma listed in the index. There is a short description in Taber's medical Dictionary. Does this mean it is a dental problem rather than a combination dental and medical. Or was it not a problem many years. back. Gail > >>>Duh ! > >>>Where did you get your dental degree ? Sears & Roebuck ? [quoted text clipped - 8 lines] > > IKYABWAI > The older medical books and some newer one do not even have amelioblastoma > listed in the index. It used to be known as an "adamantinoma of the mandible". Steve There is a short description in Taber's medical > Dictionary. Does this mean it is a dental problem rather than a > combination dental and medical. Or was it not a problem many years. [quoted text clipped - 13 lines] >> >>IKYABWAI >> The older medical books and some newer one do not even have amelioblastoma >> listed in the index. > > It used to be known as an "adamantinoma of the mandible". > >Steve And IIRC has always been spelled "amel*o*blastoma", no "i". / -- Whamatus Bemoana wubbabubbazG@RBAGE at yahoo dot com >>> The older medical books and some newer one do not even have amelioblastoma >>> listed in the index. [quoted text clipped - 9 lines] >Whamatus Bemoana >wubbabubbazG@RBAGE Tha'ts obviously my error. I must have copied it wrong from what the DDS's secretary gave me. >at yahoo dot com > My DDS removed a lesion that has been biopsied as an amelioblastoma. It > penetrated the bone from inside of the jaw to outside. Biopsy did not > include any normal bone/tissue so it is assumed that excision did not get > back to "good" bone. DDS is going to review actual cell sample as there is a > suspicion that it may be aggressive I have read the rest but only have one ccomment: The resection can be done by an oral/maxillofacial surgeon (obviously, my first choice, other things being equal), an ENT or a plastic surgeon. Now for the other things being equal part: I, for one, don't think the DDS should have done a biopsy here in this case (although hindsight is always 100 percent...) My reasoning is: if you are living in a city/town with complete hospital surgical services (operating room) and PATHOLOGY departments, it should be done there. They will resect the tumor, have it examined while you are still anesthetized, and decide whether they have good margins or not, and if not, they will resect/examine until they _do_. I would say that for the reconstruction, the OMFS must be THE person involved. BUTT; the RESCECTIVE SURGERY should be done by the surgeon/pathologist team who has the most experience with ameloblastoma management. That may be any one of the OMFS,ENT or plastics person in your particular area. The key is immediate PATHOLOGICAL examination, and a clear plan depending on the extent of surgery. There are some lesions that the DDS/DMD should leave alone for the above mentioned reasons. Maybe your guy does know about these things, but even then, I feel he should have done it in-hospital with apporpriate competency in pathological histology waiting in the wings. This is important for ameloblastoma tumors, as they are NOT cancers, but they are VERY aggressive; you have to get it all out, and that is where the immediate pathological examination comes in. If you don't get it all, it will recurr. Hope you get a good team SP SignatureTake out the TRAASH to reply >> My DDS removed a lesion that has been biopsied as an amelioblastoma. It >> penetrated the bone from inside of the jaw to outside. Biopsy did not [quoted text clipped - 35 lines] >Hope you get a good team >SP I don't kow if OP refers to me; I don't know what OP stands for. Assuming I'm the OP, here's a bit more specifics of my situation. The DDS is an OMFS, one of two in my rural town. This whole thing started as an excision of what was initially identified as a pregnancy tumor. As to whether an incisional biopsy should have been done or not, I'm not sure what the protocol is for a pregnancy tumor. The procedure was done in the office with a local. Not knowing what to really expect, I assumed all the bone excision was just part of the procedure. It took a week to get the biopsy back and that indicated the ameloblastoma. As far as the radiological translucency, Can't tell you since I had only looked up pregnancy tumor on the web. The ameloblastoma was not in my sights. Whether my DDS has ever treated one, I didn't ask. Oversight on my part. There were no clear margins. The biopsy merely indicated that there was not any normal tissue as part of the material sent down to biopsy. I'm merely at the front end of this right now. The DDS said he, personally, needed to revirew the cell detail of the biopsied material. The DDS's course of action is to see if new bone starts to grow in where it was removed from the jaw. Based upon what I'm reading here, that approach is not the most judicious. What I here is that the DDS must be as aggressive in treating this as is the characteristic of the tumor itself. His plan was that, if after observing the area, further surgery was necesaary, it would be done in the hospital, under a general. The hospital does have an onsite pathology lab, but I don't think they give online-real-time results. My reason of intially posting to this message board was to get the type of feedback that I'm seeing here, to see how seriously I should be taking this and what type of questions I should be asking and what type of results that I should be expecting. I get the very definite impression that further surgery is a normal expectation; one shot deals rarely, if ever, work. I also was (am) very concerned about the financial issue. Money doesn't come easy to me, as I assume it doesn't for most people. I did hit upon an example in the Medicare site that indicated Medciare would cover all costs associated with the removal of the tumor. They would not cover the extraction of any necessary teeth nor would they cover any of the subsequent post-surgery dental. So I guess, at least for now, signing up for Medicare Part B would give me better coverage than my current private plan seems to give, as long as the DDS I'm currently using accepts Medicare. I hate to sound like I'm overwhelmed by this, but with all the other things going on in my life right now, I am. I haven't given this the time/effort/research that I would typically give to business issues that our small (husband and wife) venture face. >>>My DDS removed a lesion that has been biopsied as an amelioblastoma. It >>>penetrated the bone from inside of the jaw to outside. Biopsy did not [quoted text clipped - 81 lines] > time/effort/research that I would typically give to business issues that our > small (husband and wife) venture face. If the biopsy was done on a presumed pregancy "tumor", then a soft-tissue biopsy was entirely appropriate. I think I have heard of pregnancy tumors VERY occasionally being associated with bone loss. I don't think you should assume that proper wide excisions of ameloblastomas usually recur. However, if there was any evidence of tumor at the margins of the biopsy specimen it certainly will recur, and should be dealt with sooner rather than later. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Are you sure about the OMFS degree? Most rural towns don't have one OMFS, much less two. Hopefully you are correct and maybe 'rural' to you is different than 'rural' to me. Best wishes, Dartos > I don't kow if OP refers to me; I don't know what OP stands for. Assuming > I'm the OP, here's a bit more specifics of my situation. The DDS is an OMFS, > one of two in my rural town. > I hate to sound like I'm overwhelmed by this, but with all the other things > going on in my life right now, I am. I haven't given this the > time/effort/research that I would typically give to business issues that our > small (husband and wife) venture face. >Are you sure about the OMFS degree? Most rural towns don't have >one OMFS, much less two. Hopefully you are correct and maybe 'rural' [quoted text clipped - 9 lines] >> I hate to sound like I'm overwhelmed by this, but with all the other things >> going on in my life right now, I am. I haven't given this the Rural, there's three towns in my "community" that are more or less a contiguous city of approximately, 20,000+, including the outlying bedroom communiities that are within a 15 mile radius. Yes, rural is a relative term when you come from an area of 1 million or so that has 5 hospitals. He is a bona fide OMFS > Rural, there's three towns in my "community" that are more or less a > contiguous city of approximately, > 20,000+, including the outlying bedroom communiities that are within a 15 > mile radius. Yes, rural is a relative term when you come from an area of 1 > million or so that has 5 hospitals. He is a bona fide OMFS Good! Thanks for the info. I started out on a farm 15 miles north of a town of 2,000 that was 21 miles from a town of 10,000. I now live and practice in a town of 6,000. Quite easy to see why we might have differing ideas of the term 'rural'. Best wishes, Dartos >> My DDS removed a lesion that has been biopsied as an amelioblastoma. It >> penetrated the bone from inside of the jaw to outside. Biopsy did not [quoted text clipped - 14 lines] >anesthetized, and decide whether they have good margins or not, and if >not, they will resect/examine until they _do_. When you receive the biopsy report, that piece of paper and all its descriptions tell you how to treat it definitively. Resection is a far cry from enucleation or curretage. Big problems entail resecting when you should have curreted and vice versa. >I would say that for the reconstruction, the OMFS must be THE person >involved. BUTT; the RESCECTIVE SURGERY should be done by the [quoted text clipped - 16 lines] >Hope you get a good team >SP > When you receive the biopsy report, that piece of paper and all its > descriptions tell you how to treat it definitively. Resection is a far > cry from enucleation or curretage. Big problems entail resecting when > you should have curreted and vice versa. 'K. Thanks for the clarification. This is just one more reason that the Original Poster should perhaps go to a board certified OMFS and have the treatment plan reviewed. SP SignatureTake out the TRAASH to reply |
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