CASE REPORT 1

A 3 ½ YEAR OLD MALE CHILD REPORTED TO THE DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY WITH THE CHIEF COMPLAINT OF SWELLING IN LEFT SIDE OF THE FACE IN MIDDLE 1/3RD REGION SINCE 2 1/2 YEARS. THE PARENTS OF THE CHILD GAVE A HISTORY OF HIM BEING APPARENTLY NORMAL TILL THE AGE OF 1 YEAR. FOLLOWING THIS, THE PARENTS NOTICED A SMALL PAINLESS SWELLING IN THE UPPER LEFT BACK REGION OF JAW. THEY APPLIED SOME LOCAL HERBAL MEDICATION ON THE SWELLING AND THERE WAS TEMPORARY RELIEF. HOWEVER, THE SWELLING CONTINUED TO INCREASE IN SIZE. THE CHILD WAS THEN REFERRED FROM MEWAD HOSPITAL TO THE DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY, SGT DENTAL COLLEGE AND HOSPITAL FOR FURTHER MANAGEMENT.

ON EXAMINATION, A SWELLING OF APPROXIMATELY 8CM X 4 CM IN SIZE WAS SEEN IN THE MID-FACE REGION. THE SWELLING WAS HARD IN CONSISTENCY, NON TENDER AND NON FLUCTUANT.

PATIENT UNDERWENT AN INCISIONAL BIOPSY FOR THE LESION IN 2010 WHICH SUGGESTED AMELOBLASTOMA. CBCT OF THE FACE WAS DONE IN 2010 AND IT GAVE THE IMPRESSION OF ODONTOGENIC CYST/AMELOBLASTOMA.

PATIENT THEN REPORTED TO OUR UNIT IN 2012. INCISIONAL BIOPSY REVEALED AMELOBLASTIC FIBROMA AND CBCT OF THE FACE WAS DONE WHICH GAVE AN IMPRESSION OF HEMANGIOMA/RHABDOMYOSARCOMA.

PRE-OPERATIVE PICTURES

FRONTAL VIEW	INTRA-ORAL VIEW	3D CT SCAN

OPERATIVE PROCEDURE

PATIENT UNDERWENT HEMI-MAXILLECTOMY-LEFT SIDE USING WEBER FERGUSSON INCISION UNDER G.A. SUPERIORLY, THE FLOOR OF THE LEFT ORBIT WAS NOT INVOLVED IN THE LESION. INFERIORLY, THE LESION INVOLVED THE LEFT ALVEOLAR RIDGE AND TEETH. MEDIALLY, THE LEFT NASAL FLOOR WAS INVOLVED AND THE NASAL SEPTUM WAS INTACT. LATERALLY, THE BUCCAL CORTICAL BONE WAS INVOLVED. ANTERIORLY, THE ANTERIOR WALL OF MAXILLA WAS INVOLVED IN THE LESION AND POSTERIORLY, THE POSTERIOR WALL OF MAXILLA WAS INTACT. PRIMARY CLOSURE WAS ACHIEVED USING 4-0 VICRYL SUTURE FOR MUCOSA. SKIN CLOSURE WAS DONE USING 4-0 PROLENE SUTURE AND DERMABOND. THE SURGICAL SPECIMEN WAS SENT FOR BIOPSY WHICH REVEALED AMELOBLASTIC FIBROMA.

INTRA-OPERATIVE PICTURES

	POSTOPERATIVE PHOTOGRAPHS

IMMEDIATE POST-OPERATIVE RESULTS ARE PROMISING. THE CHILD IS COMFORTABLE. PARENTS OF THE CHILD ARE SATISFIED WITH THE TREATMENT. HE IS UNDER OBSERVATION AND FOLLOW-UP PHASE.