Saif Ud Din.
Liquid Nitrogen application in a recurrent Giant-Cell Lesion.
J Coll Physicians Surg Pak Jan ;12(10):645-7.

In July 1992, a 13 years old male reported to the dental department with a swelling in the body of mandible on right side caused by a lesion which erupted into the buccal vestibule through perforation of cortical plate. About eight months back he had undergone excision and curettage of the lesion, but a few weeks later the wound cavity was refilled by mass recurrence. The microscopic picture of the submitted tissue revealed fragments of stratified squamous epithelium. There were multi-nucleated giant cell and spindle shape cells were also present along with occasional mitotic activity. Histopathological report was consistent with giant cell lesion. Although patient had marked facial asymmetry caused by enlarging mandibular lesion, he had no pain, bleeding or paraesthesia. There was no history of earlier external trauma, except extraction of grossly carious 1st premolar in the lesion area. Clinical examination showed normal occlusion, full range mandibular motion without deviation. The patient was afebrile and his medical history was significant. Antero-posterior radiograph of the mandible showed a well defined radiolucency in the right body of the mandible extending from distal surface of the canine tooth to the angle of the mandible. In July 1992, patient was once again operated under G.A, the tumor mass was removed by excision and vigorous curettage of the lesion socket and associated root surfaces of the involved teeth in the lesion area. Brisk bleeding was controlled by intra-operative tight packing. Blood loss during curettage was compensated by blood transfusion. Pathological fracture prevented with great care during procedure. The bony defect was packed open. Postoperative dense paraesthesia along inferior alveolar nerve distribution was felt by the patient. Within two weeks of postoperative period, the mass re-erupted from the base and along the walls of bony socket. On trial basis liquid nitrogen swab packing of the socket was used to destroy the residual tissues left behind in the socket by cryo-lysis. This chemical is commonly used in dermatology for elimination of skin out-growths. Patient responded well to repeated liquid nitrogen swab packing and wound toilet within six-week period. Antero-posterior radiograph (Figure 2) taken after 17 months of treatment showed a significant degree of bony reconstitution of the mandible. Patient had complete recovery of inferior alveolar nerve sensation. No recurrence was seen over a 9 years follow up.

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