The oral cavity and both jaws often develop some cysts or tumors which may or may not be cancerous in nature. These pathologies need to be diagnosed well to be treated efficiently. More often than not an incisional biopsy might be needed for diagnosing the exact nature of the disease . After basic workup and radiological investigations, treatment needs to be tailor made for a specific patient. Treatment defers from case to case depending on different scenarios and patient ages so as to avoid over treatment.
Dr Nisheet has been managing such cases with successful outcomes. He prefers to be conservative enough in his approach but at the same time is cautious enough to make sure that the disease is treated completely and a risk of reoccurrence is minimal.
Dr. Nisheet is also trained to manage cancers of the jaws during his speciality studies. He does manage such cases as and when they come. If needed he also teams up with reconstructive surgeons to give the patient a much better reconstructive option and a better quality of life post surgery.
Most common oral pathologies that occur include Dentigerous cyst, Ameloblastoma, Odontogenic keratocyst, Periapical cyst or Radicular cyst.
It is associated with an unerupted or impacted tooth. The nutritional sac around the tooth (dental follicle) in a few unerupted teeth start enlarging and form a sac like structure which is known as a cyst. Generally the first complain is of a painless swelling which develops slowly over a long period of time. It is usually painless unless it gets infected. Depending on the size of the cyst, the treatment is complete removal of the cyst lining along with the impacted tooth. Dr Nisheet has been treating such cases for the past decade with good results. He usually treats it on the lines of a cystic ameloblastoma which has similar features on xray. Patients are advised to keep a regular follow up to make sure that there are no recurrences.
These cystic lesions develop slowly over a period of time into the bone and do not show any symptoms unless they get infected. They do not show any significant swelling as they grow within the bone. They are treated by either curettage (scraping and cleaning ) in toto or by a more conservative approach called Marsupilization ( it requires two staged surgery and a regular cleaning of the cavity). If the cyst grows to a very large size or involves the jaw joint or surrounding soft tissue, treatment of choice is resection of the jaw and reconstruction of the same with either a bone from other part or with a Titanium reconstruction plate to maintain the shape of the jaw. Even in case of recurrence of the cyst, resection of the jaw is the treatment of choice.
It is an aggressive benign tumor (non cancerous) and mostly involves the lower jaw. There are many variants of the same. If it manifests as a single cystic lesion ( it mimics a dentigerous cyst) Dr Nisheet believes in treating it conservatively with enucleation (entire cystic wall is removed) and applying a special chemical (Carnoy’s solution) which helps in reducing chances of recurrence. (Pic) If Ameloblastoma is a solid variety , jaw resection is the treatment of choice followed by reconstruction with either a titanium plate or a free bone flap from another area of the body.