Introduction
Oral and Maxillofacial (OMF) pathology involves the diagnosis and treatment of local and systemic disease occurring in the oral cavity, jaws, face, and neck regions. Maxillofacial pathologies can range from simple benign lesions to aggressive destructive lesions or malignant tumors. The occurrence is variable and can be symptomatic or asymptomatic and may also have systemic involvement. The most common symptoms are pain, swelling, alteration of the appearance of the skin or mucosa, abnormal growth or bony expansion. Other symptoms can include: difficulty swallowing, difficulty breathing, numbness, bleeding, and also systemic symptoms like fever, chills and weight changes. Infection is a common pathology in the maxillofacial region. It can originate in the dental area or can be the result of a secondarily infected tumor. One of the surgeries that a maxillofacial surgeon is called upon to treat urgently is an odontogenic infection that impedes the airways and could compromise breathing. This life-threatening infection will need to be treated immediately.
Diagnosis
While some lesions can be diagnosed clinically by the OMF surgeon, most maxillofacial pathology requires taking a tissue specimen which is submitted to a pathologist to analyze it under the microscope. This is called a biopsy. Based on the history of occurrence and how the tissue looks under the microscope, the pathologist will provide a pathologic diagnosis. Based on the history of presentation and how the tissue looks under the microscope, the pathologist will provide a pathologic diagnosis. This process can take up to 2 weeks depending on the hospital centre. The pathologic diagnosis is then reviewed by the treating surgeon and correlated with the history of the presentation, the clinical appearance of the lesion, and then a final diagnosis is established. The biopsy is called incisional when only a small part of the lesion is taken for diagnosis. The biopsy is referred to as incisional when the whole lesion is removed as part of the diagnosis and treatment. The type of biopsy is based on the most likely diagnosis of the lesion as well as its size.
Treatment
Once a definitive diagnosis is established, a treatment plan is formulated. It can include medical treatment without surgical intervention, or can range from local excision of the lesion to a large resection, removing not only the lesion but also normal tissue around it. This is followed by reconstruction as needed.
Training
Oral and Maxillofacial surgeons are trained to manage benign pathology in the oral and maxillofacial region. OMF surgeons can continue their training for an extra year or two at the fellowship level to learn how to manage malignant tumours in the maxillofacial region and also to learn advanced reconstructive techniques.
Case
It is a case of a 32 year-old female who presented originally presented left mandible pain, swelling, and bony expansion. An incisional biopsy revealed ameloblastoma, a benign but locally detructive tumour. The treatment involved a partial resection of the left mandible, and reconstruction with free vascularized fibula from the leg. Eventually the patient received dental implants and prosthetic restoration resulting in complete oral rehabilitation.
