Ok, I have a lytic lesion in my jaw. What could it be? Infection? Cancer? A cyst? Some sort of benign neoplasm? A space alien or retained twin? News of the weird, here I come.
Jargon Alert:
neoplasm /neo·plasm/ (ne´o-plazm) tumor; any new and abnormal growth, specifically one in which cell multiplication is uncontrolled and progressive. Neoplasms may be benign or malignant.
Orthopaedic Surgery is the study and care of maladies of the skeleton and musculoligamentous structures. The bones and the soft stuff attached to the bones is my baliwick...that is EXCEPT when it comes to bones of the skull, face or jaw. This is the realm of the Oral Surgeon, the Maxillofacial Surgeon, the Plastic Surgeon, or the Otolaryngologist. The teeth, in particular are interesting structures stemming from very specialized cells found nowhere else in the body. Special cells mean special problems. We DID NOT learn about odontogenic tumors and the like in medical school or residency. I get to learn something new.
When a doctor or scientist is looking for information about a problem, we must first narrow down the possibilities of what the issue might be because the world of medical problems is huge. When it comes to tumors/lesions etc. any clues to it's behavior is helpful. Where is it? What does it look like? How is it acting? In my case, the first step in making a diagnosis was to identify the lesion. Where it is and what it looks like are important in narrowing down the possibilities. What the lesion is doing to the bone is very important when trying to decide if it is bad (malignant) or not so bad (benign). In this case the smooth oval look on the panorex and x-rays suggest that this is likely a benign process.
Next we have to look at what possible causes of a lytic lesion in the jaw is. My job began with Google. Searching "Lytic Lesion Mandible"gave me 107,000 results. For medical conditions I first look for medical journal references, online journals and case reports. Peer reviewed journals are best for the quality of studies and reports, but may be over the head of most lay people. I stay away from (at least at first) forums, blogs, aggregators and the like. There is a lot of garbage or recycled information out there. Forums and blogs have their place, but not for collecting accurate information. Wikipedia is a good start BUT always be leery of the accuracy of the information.
Jargon Alert:
odontogenic /odon·to·gen·ic/ (-jen´ik) 1. forming teeth. 2. arising in tissues that give origin to the teeth.
Since my lesion has the appearance of a cyst (a hole in my jaw), is in the mandible/jaw, and is near my teeth, we can narrow down the focus when it comes to searching for information.
I found these two journal articles helpful in reviewing from a radiographic point of view, what the possibilities are:
These references speak more to the actual pathology of the various lesions:
And then this page, which is essentially a Wikipedia like site for Radiologists:
Ok, there are few malignant tumors of the jaw. Good. There are a lot of cysts, and other issues that are essentially minor problems. Excellent. There are a few bad actors both in the benign and the malignant world that we must look out for. Yep, there's always a catch.
With a good couple of steps towards understanding the lay of the land, so to speak, (The x-rays, the Panorex, the CT, and a review of the possible causes) there really is only one step left...BIOPSY. We need to get a sample of my little friend to send to the pathologist. They will cut it, stain it, and look at it under the microscope in order to determine the origin and it's identity. The pathologist is the CSI of neoplasm care.
Let's go get a biopsy.
No comments:
Post a Comment