oral surgery revision course 1
TRANSCRIPT
-
8/2/2019 Oral Surgery Revision Course 1
1/91
Cystic and Odontogenic Tumours LesionsOf The Jaws
Dr Ashraf Abu KarakyThe University of Jordan
Oral surgery Revision Course
2012
-
8/2/2019 Oral Surgery Revision Course 1
2/91
Definition
A cyst is defined as a pathologicalcavity containing fluid, semifluid orgaseous material other than pus. It
is frequently but not always linedby epithelium.
-
8/2/2019 Oral Surgery Revision Course 1
3/91
Diagnosis of Radiolucent Lesionsof the Jaws
Step 1
Systematically describe theRL
. Site
. Size
. Shape
. Outline/ edge or periphery
. Relative radiodensity
. Effects on adjacentsurrounding structures
. Time present
-
8/2/2019 Oral Surgery Revision Course 1
4/91
Step 2
Decide whether or not the RLis:
1- A normal anatomicalstructure
2- Artefactual
3- Pathological:a.Congenital.
b.Developmental
c. Acquired
-
8/2/2019 Oral Surgery Revision Course 1
5/91
Step 3IF acquired RL:- Infection; Localized to apical
tissueSpreading within the
jaw- Traumatic lesions- Cysts- Tumours- Giant cell lesions- Fibro-cemento-osseous
lesions- Idiopathic lesions
-
8/2/2019 Oral Surgery Revision Course 1
6/91
Step 4
Consider the
classification andsubdivision of cystsand other RL s withineach of the other main
disease categories
-
8/2/2019 Oral Surgery Revision Course 1
7/91
Step 5
Compare the radiologicalfeatures of the unknownRL with the typical RGfeatures of these possible
conditions.Construct a list showing in
order of likelihood all theconditions that the lesionmight be (radiologicaldifferential diagnosis)
-
8/2/2019 Oral Surgery Revision Course 1
8/91
Odontogenic cysts
Developmental 1.Dentigerous cyst
2.Eruption cyst
3.Odontogenic keratocyst
(keratocystic odontogenictumor*)
4.Orthokeratinized odontogeniccyst
5.Gingival cyst of the newborn
6.Gingival cyst of the adult
7.Lateral periodontal cyst 8.Glandular odontogenic cyst
Inflammatory origin 1.Periapicalcyst (radicular cyst;
Apical periodontal cyst)
2.Residual periapical (radicular)cyst
3.Buccal bifurcation cyst
-
8/2/2019 Oral Surgery Revision Course 1
9/91
Non-Odontogenic Cysts
1. Fissural Cysts- Nasopalatine duct cyst- Nasolabial cyst- Median Madibular Cyst- Median Palatine Cyst- Globulo-Maxillary Cyst
2. Bone Cysts- Solitary bone cyst- Aneurysmal bone cyst- Stafne Cyst ( Lingual SalivaryGland Inclusion Defect)
3. Soft tissue cyst
- Dermoid- Branchial- Thyroglossal duct cyst
- Salivary cyst
-
8/2/2019 Oral Surgery Revision Course 1
10/91
-
8/2/2019 Oral Surgery Revision Course 1
11/91
Inflammatory OdontogenicCysts
Radicular
Residual
LateralParadental
-
8/2/2019 Oral Surgery Revision Course 1
12/91
Radicular Cyst
Develops from the epithelial remnants ofHertwig s sheath- the cell rests ofMalassez
Age usually adults, 20-50 yrs
Frequency: most common of all jaw cysts
(70%)
-
8/2/2019 Oral Surgery Revision Course 1
13/91
Typical radiographic features
Site: Apex of any non-vitaltooth.
Size: Usually 1.5-3cm indiameter
Shape: Round
Monolocular
Outline: Smooth
Well defined
Well corticated iflongstanding and
continuous with the laminadura of the associatedtooth
Radiodensity: Uniformlyradiolucent
-
8/2/2019 Oral Surgery Revision Course 1
14/91
Cont.// Radiographic Features
Effect: Adjacent teeth-displaced, rarelyresorbed
Buccal expansion
Displacement of
the antrum
-
8/2/2019 Oral Surgery Revision Course 1
15/91
Residual Cyst
This term refers to radicular (dental)cyst remaining after the causativetooth has been extracted
Age: Adults > 20yrs
Site: Apical regions of tooth bearingportion of the jaws
-
8/2/2019 Oral Surgery Revision Course 1
16/91
Typical radiographic features
Size: Variable, 2-3 cm indiameter
Shape: Round, Monolocular
Outline: Smooth, Welldefined
Usually wellcorticated
Radiodensity: Uniformlyradiolucent
Effects: -adjacent teeth
displaced, rarelyresorbed
-Buccal expansion
-Displacement of the
antrum
-
8/2/2019 Oral Surgery Revision Course 1
17/91
Lateral Radicular Cyst
Form at the side of anon-vital tooth asa result of opening
of a lateral branchof the root canal.
-
8/2/2019 Oral Surgery Revision Course 1
18/91
Paradental Cyst
Results frominflammationaround partially
erupted teeth,particularlymandibular thirdmolars.
Age: 20-25yrs
Teeth Vital-Pericorinitis
-
8/2/2019 Oral Surgery Revision Course 1
19/91
Developmental Cysts
- Odontogenic Keratocyst
- Follicular cyst Dentigerous cystEruption Cyst
- Lateral Periodontal cyst
- Glandular Odontogenic Cyst- Gingival Cyst of Adults- Gingival Cyst of Newborn (EpsteinPearls)
-
8/2/2019 Oral Surgery Revision Course 1
20/91
Dentigerous (follicular cyst)
Develop from the remnants of the reduceddental epithelium
Age: Usually adolescents or young adults(20-40yrs), occasionally the elderly.
Frequency: About 20% of all Cysts
-
8/2/2019 Oral Surgery Revision Course 1
21/91
Typical radiographic features
Site: Associated with the crown of anunerupted and displaced tooth,typically teeth where eruption isimpeded, e.g. upper 3, lower 8
Size: Very variable, cyst suspected iffollicular space exceeds 3 mm butmay grow to several cms in
diameter and extend up into theramusShape: - Round or oval, typically
enveloping the crownsymmetrically
- Monolocular- 3 varieties are described
depending on the cyst crown
relationship; central,lateralcircumferential
-
8/2/2019 Oral Surgery Revision Course 1
22/91
Cont.// Radiographic Features
Outline: - Smooth- Well defined- Often Well Corticated
RD: Uniformly RL
Effects: - Associated tooth;unerupted and displaced
- Adjacent teeth:DisplacedRarely resorbed
- Buccal or medialexpansion, can be extensive
with large cysts causing facialasymmetry and displacementof the antrum
-
8/2/2019 Oral Surgery Revision Course 1
23/91
Eruption Cystdentigerous cyst in the
soft tissue
-
8/2/2019 Oral Surgery Revision Course 1
24/91
Odontogenic Keratocyst
Develop from the epithelium of the dentallamina (the cell rests of Serres)
Age: Very variable, 2nd and 4th decade
Frequency : less than 5% of all odontogenic
cysts
-
8/2/2019 Oral Surgery Revision Course 1
25/91
Radiographic Features
Site: Posterior body / angleof the mandible extendingto the ramus
Anterior maxilla incanine regionSize: Variable, but often largein the mandibleShape: - Oval, extendingalong the body of themandible with littlemediolateral expansion
- Pseudolocular ormultilocularOutline: -Smooth
- Well defined- Often well
corticated
-
8/2/2019 Oral Surgery Revision Course 1
26/91
Cont// Radiographic Features
Radiodensity: Uniformlyradiolucent
Effects: - Adjacent teeth-minimal displacement,
rarely resorbed- Extensive
expansion
within cancellous bone
typically out of theproportion to the minimaldegree of medio-lateral
expansion.
-
8/2/2019 Oral Surgery Revision Course 1
27/91
Gorlin s Syndrome (nevoidbasal cell carcinomasyndrome)
Multiple OdontogenicKeratocysts
Multiple Basal CellCarcinomas
Skeletal Anomalies, e.g. bifidribs and calcification of the
flax cerebri.
-
8/2/2019 Oral Surgery Revision Course 1
28/91
Developmental Lateral PeriodontalCyst
Uncommon developmentalintraosseous cysts form beside avital tooth.
Age: Variable
Frequency: Uncommon
-
8/2/2019 Oral Surgery Revision Course 1
29/91
Radiographic Features
Site: Between roots oflateral incisor andcanine
Size: Usually small in
sizeShape: Round
Outline: Well-demarcated
RD: RLEffect: Adjacent teeth-May be displaced
May erodethrough the bone to
extend into
-
8/2/2019 Oral Surgery Revision Course 1
30/91
Glandular Odontogenic Cyst
Very rare
Age: Middle- aged adults49yrs
Site: 89% Mandible, anteriorregion
many cross the midlineSize: vary up to several cms
RD: Uniformly RL
Shape: multilocular stunilocular
Outline: Well demarcatedEffects: Expansion
Paresthesia
-
8/2/2019 Oral Surgery Revision Course 1
31/91
Gingival Cyst
Dental lamina cystsof the newborn,(Bohns
nodules;Epsteinspearls)
Gingival cysts ofadults: st erode
the underlyingbone
-
8/2/2019 Oral Surgery Revision Course 1
32/91
-
8/2/2019 Oral Surgery Revision Course 1
33/91
Non-Odontogenic Cysts
Developmental Cysts
Nasopalatine duct cystNasolabial cyst
Median Palatine Cyst
Globulo-Maxillary CystMedian Mandibular Cyst
-
8/2/2019 Oral Surgery Revision Course 1
34/91
Nasopalatine Duct / Incisive Canal
CystDevelop from epithelial remnants ofNasopalatine Duct or Incisive Canal.
Age: Variable, but most frequentlydetected in middle age (40-60 yrsolds).
Frequency: Most Common of all non-
odontogenic cysts, 1% of totalpopulation
-
8/2/2019 Oral Surgery Revision Course 1
35/91
Radiographic Features
Site: Midline, anterior maxillajust posterior to the uppercentral incisorsSize: Variable, but usually from6mm to several cm s indiameter.
Shape: Round or OvalMonolocularOutline: Smooth
Well definedWell corticated
RD: Uniformly RL but RO
shadows st superimposedEffects: -Adjacent teeth- distaldisplacement, rarely resorbed
-Palatal expansion
-
8/2/2019 Oral Surgery Revision Course 1
36/91
Differentiation between NasopalatineDuct Cyst and a large normalNaopalatine foramen?
. Size
. Outline
. Relative RD
. Shape?
-
8/2/2019 Oral Surgery Revision Course 1
37/91
Median mandibular cyst
Develop from embryonic epithelial remnants
in the symphyseal region of the mandible
-
8/2/2019 Oral Surgery Revision Course 1
38/91
Median Palatine Cyst
-
8/2/2019 Oral Surgery Revision Course 1
39/91
Globulo-Maxillary Cyst
-
8/2/2019 Oral Surgery Revision Course 1
40/91
Nasolabial Cyst
Rare fissural cyst, ariseat the junction of theglobular process, thelateral nasal process
and the maxillaryprocess as a result ofproliferation ofentrapped epitheliumalong the fusion line.
X-ray findings arenegative
-
8/2/2019 Oral Surgery Revision Course 1
41/91
-
8/2/2019 Oral Surgery Revision Course 1
42/91
2. Bone Cysts
-Solitary bone cyst- Aneurysmal bone cyst
- Stafne Cyst ( Lingual Salivary GlandInclusion Defect)
-
8/2/2019 Oral Surgery Revision Course 1
43/91
Solitary (simple) bone cyst
Unknown aetiology, may be associated withtrauma.
Age: Children and young adults < 20yrs
-
8/2/2019 Oral Surgery Revision Course 1
44/91
Radiographic Features
Site: Premolar and Molar region ofthe Mandible
Rarely, anterior MaxillaSize: Variable, up to several cmsShape: Monolocular
Irregular, upper borderarches between the roots of the
teethOutline: - Smooth and undulating
- Moderately well defined- Moderately well or poorly
corticatedRD: uniformly RLEffects: - Adjacent Teeth- minimal or
no displacement, v rarelyresorbed
- Minimal or no expansionof the jaw
-
8/2/2019 Oral Surgery Revision Course 1
45/91
Aneurysmal Bone Cyst
More accurately classified as Giant CellLesion
Localized non-neoplastic proliferative lesionof vascular tissue, containing Giant Cells.
Age: Usually < 20yrs old
Frequency: Rare.
-
8/2/2019 Oral Surgery Revision Course 1
46/91
Radiographic Features
Site: Body/ posterior mandibleMaxilla occasionally
Size: Variable, up to several cmsShape: - Mono or Multilocular
- Faint internal trabeculation, mayproduce a soap-bubble appearance.Outline: - Smooth
- Moderately well defined- Peripheral cortex even when
largeRD: RL with evidence of faint, randominternaltrabeculationsEffects: - Adjacent teeth- displaced, rarelyresorbed
- Buccal and lingual expansion of
the cortex, often marked anddescribed as Ballooning or Blow-Out
S f C ( Li l S li
-
8/2/2019 Oral Surgery Revision Course 1
47/91
Stafne Cyst ( Lingual SalivaryGland Inclusion Defect)
Well defined
depression in thelingual surface ofthe posterior bodyof the mandible
Usuallyasymptomatic andare incidental
RG finding
-
8/2/2019 Oral Surgery Revision Course 1
48/91
Radiographic Features
Site: usually near the angleof the mandible, above theinferior border, inferiof tothe mandibular canal andposterior to the third molar
Size: can penetrate themandible to depthsextending from the lingualto the buccal cortex
Shape: Ovoid or Rectangular
Outline: - Well defined
RD: Uniformly RL
Effects : Incidental
-
8/2/2019 Oral Surgery Revision Course 1
49/91
3. Soft tissue cyst
- Dermoid- Branchial
- Thyroglossal duct cyst
- Salivary cyst
-
8/2/2019 Oral Surgery Revision Course 1
50/91
Dermoid Cyst
-
8/2/2019 Oral Surgery Revision Course 1
51/91
Branchial Cyst
-
8/2/2019 Oral Surgery Revision Course 1
52/91
Thyroglossal Duct Cyst
-
8/2/2019 Oral Surgery Revision Course 1
53/91
Salivary Cysts
C l if i Od t i C t
-
8/2/2019 Oral Surgery Revision Course 1
54/91
Calcifying Odontogenic Cyst(Gorlin Cyst)
Classified by WHO as odontogenic tumour
Presents typically as radiolucencyresembling other odontogenic cysts
As it develops, a variable amount of calcifiedmaterial becomes evident, scattered
throughout the RL. The RO can range fromsmall flecks to large masses.
Age: Variable, usually adults < 40 yrs old
-
8/2/2019 Oral Surgery Revision Course 1
55/91
Radiographic Features
Frequency: rareSite: Usually mandible (70%)-anterior or premolar regions,occasionaly associated with anodontome or errupted tooth.Size: Usually small, 1-3 cm indiameter but can become verylarge, involving much of themandible.Shape: Variable, but usuallymonolocularOutline: Smooth, well defined
Often corticatedRD: initially RL, in advanced lesions variable amount of calcified RO
materialEffects: - Adjacent teeth usuallydisplaced and / or resobed
- Bony expansion
-
8/2/2019 Oral Surgery Revision Course 1
56/91
-
8/2/2019 Oral Surgery Revision Course 1
57/91
Odontogenic Tumours
-
8/2/2019 Oral Surgery Revision Course 1
58/91
A complex group of lesions of diversehistopathologic types and clinicalbehavior
Some are true neoplasms and mayrarely exhibit malignant behavior,others may represent tumour- like
malformations.
-
8/2/2019 Oral Surgery Revision Course 1
59/91
WHO Classification
BenignOdontogenic epithelium without
odontogenic ectomesenchyme
Odontogenic epithelium withodontogenic
ectomesenchyme, with orwithout dental hard-tissueformation
Odontogenic ectomesenchymewith or without includedodontogenic epithelium
MalignantOdontogenic carcinomas
Odontogenic sarcomas
Odontogenic carcinosarcomas
Neoplasms andother lesionsrelated to bone
Osteogenic neoplasmsNon-neoplastic bone lesions
Other tumoursmelanotic neuroectodermal tumour
of infancy (melanotic progonoma)
http://radiopaedia.org/articles/missing?article%5Btitle%5D=melanotic+neuroectodermal+tumour+of+infancyhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=melanotic+neuroectodermal+tumour+of+infancyhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=melanotic+progonomahttp://radiopaedia.org/articles/missing?article%5Btitle%5D=melanotic+progonomahttp://radiopaedia.org/articles/missing?article%5Btitle%5D=melanotic+neuroectodermal+tumour+of+infancyhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=melanotic+neuroectodermal+tumour+of+infancy -
8/2/2019 Oral Surgery Revision Course 1
60/91
Amelobastoma
The Most Important and The MostCommon Clinically Significant
Frequency equals the combinedfrequency of all other odontogenictumours excluding odontomas.
Arise from: rests of dental laminadeveloping enamel
organ Epithelial lining of anodontogenic cyst
Basal cells of oralmucosa
Slow growing, locally invasive,benign course in most cases
Three different clinicoradiographicsituations
1. Conventional solid or multicystic(86%)
2. Unicystic (13%)3. Peripheral (extraosseous 1%)
Conventional solid or Multicystic
-
8/2/2019 Oral Surgery Revision Course 1
61/91
Conventional solid or MulticysticIntraosseous Amelobastoma
Age: 3rd to 7thdecade
Gender: M=F
Race: Some studies> Blacks
Site: 85% Mandiblemolar-ascendingramus
15% Maxilla
-
8/2/2019 Oral Surgery Revision Course 1
62/91
Clinical presentation:Often AsymptomaticPainless swelling or
expansionIf untreated may growto massiveproportions
Pain and Paraesthesiaonly if large and areuncommon
-
8/2/2019 Oral Surgery Revision Course 1
63/91
RG: Multilocular RLlesion
Buccal and
lingual expansionRoot resorption
is common
Oftenassociated with anunerrupted tooth(3rd molar)
-
8/2/2019 Oral Surgery Revision Course 1
64/91
Histopathology
Most tumours has a varying combinations ofcystic and solid features
Has several microscopic patterns, generallyhas little bearing on the behavior of thetumour
Large Tumours show a combination ofmicroscopic patterns
Most common: Follicular and plexiformLess common: Acanthomatous, granularcell, desmoplastic and basal cell types.
-
8/2/2019 Oral Surgery Revision Course 1
65/91
Treatment and Prognosis
Simple Enucleation andCurettage: Recurrence
rate 50-90%En-Blockor Marginal
Resection with 1cm
safety marginRecurrence rate up to15%
Radiotherapy seldomused; secondary
induced malignancyesp. in young patientsIf untreated: spread to
vital structuresMetastasis
and Malignantbehavior
-
8/2/2019 Oral Surgery Revision Course 1
66/91
Unicystic Amelobastoma
10-15% of ConventionalAmelobastoma
Age: 50% in seconddecade
Site: 90% Mandible(posterior area)
Clinically: Asymptomatic,large lesions causepainless swelling of thejaws.
RG: Unilocular lesion, oftenassociated with animpacted 3rd molar.
Diagnosis only aftermicroscopic examination
-
8/2/2019 Oral Surgery Revision Course 1
67/91
Histopathology: 3 types:
1- Luminal
2- Intra- luminal
3- Mural
Treatment and Prognosis:
Enucleation and Curettage 10-20%recurrence rate
Peripheral (Extraosseous)
-
8/2/2019 Oral Surgery Revision Course 1
68/91
Peripheral (Extraosseous)Amelobastoma
Uncommon, < 1%Age: Middle Age (52 yrs)
Site: Posterior gingivaland alveolar mucosa,
Mandible>MaxillaClinically: Painless, non-
ulcerated sessile orpedunculated lesion
Histo: Same asConventionalAmelobastoma
Treatment andPrognosis: Local
surgical excision-
Malignant Amelobastoma and
-
8/2/2019 Oral Surgery Revision Course 1
69/91
Malignant Amelobastoma andAmelobastic Carcinoma
Very rare < 1%Malignant AmelobastomaAmelobastic Carcinoma
Age: 4 to 75 yrs (mean age 30)Metastasis: from 1-30 yrs
usually after 10yrs
Metastasis: Lung > Cervicallymph nodes > vertebrae andother bone
Histo and RG: Malignant sameas conventional
Amelobastic; Features ofMalignancy
RG; more aggressiveTreatment and Prognosis: En-
blockresectionVery poor > 50% die
in 5yrs
-
8/2/2019 Oral Surgery Revision Course 1
70/91
-
8/2/2019 Oral Surgery Revision Course 1
71/91
Adenomatoid Odontogenic Tumour
3-7% of odontogenictumours
WHO 1992 classifyas Mixed
Clinically and RG:2/3 in pts 10-19yrs
Uncommon > 30
Maxilla:Mandible 2:1
Anterior >>
Posterior
-
8/2/2019 Oral Surgery Revision Course 1
72/91
Usually small in size ComplexSome lesions show features of
both
-
8/2/2019 Oral Surgery Revision Course 1
75/91
Age: First two decades (ave. age 14)Clinical: Majority are Asymptomatic
Most are small in size, few can belarge and cause jaw expansion
Can interrupt teeth eruption
Site: Maxilla>Mandible
Compound can be< anterior maxilla
Complex can be < molar regionOccasionally develop completely within
gingival soft tissue
-
8/2/2019 Oral Surgery Revision Course 1
76/91
RG:Compound: collection
of tooth like structuresof varying size andshape surrounded by a
narrow radiolucent zoneComplex: Calcified masswith the radiodensity oftooth structuresurrounded by a narrow
radiolucent zoneUnerrupted tooth
frequently associatedwith odontomas
Treatment: Simple local
excision
O
-
8/2/2019 Oral Surgery Revision Course 1
77/91
Odonotgenic Myxoma
Age: young adultsM = FMandible>MaxillaAsymptomatic, if large painless
expansionRG: Uni or Multilocular RL with
bone trabeculaeill defined marginsLarge lesions: May show
Soap Bubble AppearanceTreatment: Curettage if small
Excision if large
Prognosis: Good, Recurrence25%
Cementoblastoma (True
-
8/2/2019 Oral Surgery Revision Course 1
78/91
Cementoblastoma (TrueCementoma)
Less than 1% of odontogenicTumoursSite: Mandible >>> Maxilla
Premolar and Molar Region50% First Molar
F=M
Age: Children and Young adultsClinical: > 2/3 of cases Pain and
SwellingRG: RO mass fused to one or
more tooth roots surroundedby a RL rim
Treatment: Surgical excisionwith root amputation and RCT
Or with extractionof tooth
Prognosis: Excellent
M
-
8/2/2019 Oral Surgery Revision Course 1
79/91
Management
History
Investigations
Biopsy
Diagnosis
Treatment plan
-
8/2/2019 Oral Surgery Revision Course 1
80/91
Enucleation and Curettage
Surgical Excision
Excision with Safety Margin
En-BlockExcision
E l i d C
-
8/2/2019 Oral Surgery Revision Course 1
81/91
Eucleation and Curettage
-
8/2/2019 Oral Surgery Revision Course 1
82/91
-
8/2/2019 Oral Surgery Revision Course 1
83/91
-
8/2/2019 Oral Surgery Revision Course 1
84/91
Resection
Removal of a tumour by incisingthrough uninvolved tissues around
the tumour, thus delivering thetumour without direct contact duringinstrumentation (also known an en-
blockresection)
-
8/2/2019 Oral Surgery Revision Course 1
85/91
Marginal resection (i.e., segmental)resection: resection of a tumour w/odisruption of the continuity of the bone.
Partial resection; resection of a tumour byremoving a full-thickness portion of the jaw,ex: hemimandibulectomy.
Total resection; removal of a tumour byremoval of the involved bone (e.g.maxillectomy)
Composite resection; resection of a tumourwith bone, adjacent soft tissue, andcontiguous lymph nodes channels. (this is anablative procedure used most commonly formalignant tumours).
-
8/2/2019 Oral Surgery Revision Course 1
86/91
-
8/2/2019 Oral Surgery Revision Course 1
87/91
-
8/2/2019 Oral Surgery Revision Course 1
88/91
Factors used to determine type of
-
8/2/2019 Oral Surgery Revision Course 1
89/91
acto s used to dete e type otreatment
Aggressiveness of lesion
Anatomic location of lesion
Maxilla vs mandible
Vital structures
Size of the tumour
Intra vs extra-osseous Duration of lesion
Reconstructive efforts
Immediate Vs delayed
-
8/2/2019 Oral Surgery Revision Course 1
90/91
yreconstruction
Advantages of immediatereconstruction:
Single surgical procedure
Early return to function
Minimal compromise to facial esthetics
Disadvantages;
Loss of the graft from infection
Recurrence
Thank you
-
8/2/2019 Oral Surgery Revision Course 1
91/91
Thank you