My appointment with my surgeon came up quickly. I was fortunate that Dr. W worked with Dr. M at Vanderbilt. My wife and I met with him and his chief resident late one Monday afternoon. A new panorex, a review of my medical history, and a quick exam led us to the meat of the discussion. My research really paid off. I was very prepared for our discussion.
Ameloblastoma is rare but aggressive. The most "conservative" treatment is actually the most invasive...surgery. In order to maximize the likelihood of eradication for good, we need to take out the tumor itself, as well as a good margin of normal bone to make sure we got it all. One centimeter is considered the standard for a good margin. That means that they needed to have 1cm of normal bone in front of, behind, and below the tumor (above it includes the teeth) to say goodbye to my little friend. I am fortunate that my tumor is small and is in the front part of my jaw. Most ameloblastomas are found near the angle of the jaw and can get quite large, necessitating taking out a large part of the jaw including the joint where it attaches to the skull. This makes recovery much longer, reconstruction more challenging, and risks go up.
Being in the front, however does put the mental nerve at risk. This is the nerve that gives sensation to my lip, and chin on the right side. The goal would be to take away bone whilst sparing the nerve if at all possible. Fortunately, the position of the tumor is such that the nerve may be able to be addressed and left intact. I will lose 3-5 teeth in the process, but since the bottom of the jaw is still ok, I won't likely have to have a segmental osteotomy where the entire jaw bone from teeth to the bottom of the jaw is removed. This leaves the jaw unstable, which requires plating to pieces together and wiring my jaws shut to splint the pieces. It also complicates the reconstruction.
Reconstruction of the jaw, or rebuilding the bone that is removed is done by taking bone from my hip/pelvis and putting in the jaw. Eventually the body grows together there and makes my jaw sturdy again so that teeth can be put in place. Again, I am lucky here in that the defect will not be huge, nor segmental, making reconstruction easier. Dr. M may be able to graft it at the same time that the tumor is removed. It all depend on whether he can safely close the gum and soft tissue over the graft. The worst thing in the world is if the wound dehisces and comes apart. That really increases the chance of infection, and possibly losing the graft.
Jargon Alert:
dehiscence /de·his·cence/ (de-his´ins) a splitting open.
wound dehiscence separation of the layers of a surgical wound
Surgery will take 5-6 hours. I'll be able to go home the next day. Nope....no tracheostomy since the surgery can be done from inside out. Unlikely will I need my jaws wired shut since the strongest part of my jaw will remain intact. The ability to graft will be decided at the time of surgery. Saving the nerve will be a big priority. Six weeks or so off work. Liquid or no-chew diet for 3-6 months depending on whether the graft can be done at the same time or needs to be delayed. Implants once the graft is healed and incorporated. All in all, about a year of work to re-build my mouth and restore my bite to allow me to chew properly.
Whew!
I consider myself REALLY fortunate. The lesion is small and in the front. Most ameloblastoma stories on the internet involve much bigger tumors, much bigger operations, and much longer recoveries. I am also fortunate to be in such a great community that we don't have to travel to an unknown city to find the experts who can manage this. Nashville if very fortunate to have such a place as Vanderbilt University Medical Center. I'm healthy. I have good friends and a fantastic wife. My office and practice are amazing. My patients will be understanding (although their best interest worries me the most, frankly).
Let's do it....
