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Resection oral surgery (very simplified)

Management of oral pathologic lesions by Resection.
1. Marginal/ Segmental
2. Partial
3. Total
4. Composite

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Resection oral surgery (very simplified)

  1. 1. Resection  Removal of a tumor by incising through uninvolved tissues around the tumor, thus delivering the tumor without direct contact during instrumentation.  Also known as en bloc resection.
  2. 2. Types of Jaw tumors and primary treatment modalities Marginal or Partial resection Composite Resection  Ameloblastoma  Calcifying epithelial odontogenic tumor  Myxoma  Ameloblastic odontoma  Squamos odontogenic tumor  Malignant ameloblastoma  Ameloblastic fibrosarcoma  Ameloblastic odontosarcoma  Primary intraosseous carcinoma
  3. 3. I. Marginal/Segmental Resection  Resection of a tumor without disruption of the continuity of the bone. Surgical technique Resected specimen should include the lesion and 1cm bony margins around the radiographic boundaries of the lesion. Reconstruction limited to replacing lost osseous structure (alveolus)
  4. 4. I. Marginal/Segmental Resection Surgical technique  Full thickness mucoperiosteal flap developed from bone to be removed.  Air driven surgical burs - section bone  Determine if tumor has perforated the cortical plates and invaded adjacent soft tissues . • sacrificing tissue may be necessary • supraperiosteal dissection of involved bone  Send specimens to pathologists for histopathologic exam.
  5. 5. Marginal or Segmental resection of ameloblastoma Intraoral exposure of mandible and osseous cuts made around lesion leave inferior border intact. Intraoral defect after removal of lesion
  6. 6. …cont’d(Marginal/Segmental resection of ameloblastoma) Radiographic appearance of the lesion. Its relationship to inferior border of mandible is demonstrated. Radiographic appearance immediately after graft placement
  7. 7. II. Partial Resection  Resection of a tumor by removing a full-thickness portion of the jaw.  In the mandible, this can vary from a small continuity defect to a hemimandibulectomy  Jaw continuity is disrupted.
  8. 8. Partial mandibular resection of Myxoma Lesion after sectioning
  9. 9. III. Total Resection  Resection of a tumor by removal of the involved bone.  Example: Maxillectomy and Mandibulectomy
  10. 10. III. Total resection Maxillectomy
  11. 11. IV. Composite resection  Resection of a tumor with bone, adjacent soft tissues, and contiguous lymph node channels.  This is an ablative procedure used most commonly for malignant tumors.  Surgical approach for treating cancer of the oral cavity and oropharynx, results in considerable functional and cosmetic deformity.
  12. 12. Squamous cell carcinoma of left posterior mandible. Neck dissection and Segmental resection of cancer has been completed, and a titanium reconstruction bar placed. The neck lymph nodes and left mandible cancer specimen.