Radical Procedures Research Articles

In Spite of Curative Radical Pulmonary Procedures, Lesser Pulmonary Resection Shows More Favorable Prognosis in Surgically Treated NSCLC With Synchronous Isolated Cranial Oligometastases.

Oligometastatic disease in lung cancer is not a rare condition as previously thought. Among 812 non-small cell lung cancer patients treated surgically with lung resection between October 2011 and October 2018 at the Department of Thoracic Surgery, Florence Nightingale Hospitals, Turkey, 28 patients (3.4%) had synchronous cranial metastases. We analyzed synchronous isolated cranial metastases patients treated by locally ablative treatments (surgery, radiotherapy, or both). Metastases existing at the diagnosis of primary cancer were considered as synchronous, and their treatment was performed before (at least 1 month) or after (for maximum 1 month) surgery of the primary lung lesion. Prognostic factors affecting survival are evaluated retrospectively to identify clinical factors predicting survival in an effort to better select patients for surgery. Patients having T1-T2 primary lung tumors, no mediastinal lymph node metastasis, receiving minor anatomical lung resection, receiving neoadjuvant chemotherapy, having single cranial metastasis, and receiving surgical cranial metastasectomy were found to have better survival. According to tumor histology, having adenocarcinoma, and not having lymphovascular or visceral pleura invasion correlated with better survival. Average survival time was 52.1 months and median survival was 32 months. The last mortality during the follow-up was at 24 months; cumulative survival was 48.3% at that time. Our study was designed to define the criteria for patients with oligometastatic disease who may benefit from lung resection.

The impact of adjuvant chemotherapy on oncologic outcomes of patients with locally advanced bladder adenocarcinoma: An analysis of the National Cancer Database.

495 Background: The relatively poor prognosis associated with locally advanced bladder adenocarcinoma necessitates investigation of the utility of adjuvant chemotherapy (AC) and risk stratification of those who would benefit from such systemic therapy. This study seeks to evaluate the oncologic and surgical outcomes of those with locally advanced disease treated with and without AC. Methods: A retrospective cohort analysis was performed using the National Cancer Database from 2006 to 2016. Patients with non-metastatic locally advanced pT3-4 or pT(any)N1-3 primary bladder adenocarcinoma who received AC only or did not receive AC after radical (RC) or partial cystectomy (PC) were included. The AC cohort was further sub-stratified by surgery type (PC versus RC) and disease origin (urachal versus non-urachal subtypes). Survival, oncologic, and surgical outcomes were compared between cohorts. Results: Inclusion criteria identified 79 AC patients and 251 no AC patients. Of the 79 patients who received AC, 23 had PC procedure, 56 had RC procedure, 10 had urachal origin and 69 had non-urachal origin. Receipt of AC was significantly higher in RC relative to PC (27.6% vs 18.1%; p = 0.049). Urachal vs. non-urachal subtype did not impact receipt of AC (25.3% vs 17.5%; p = 0.214), but urachal subtype was associated with improved overall survival compared to non-urachal (47% vs 18%; HR = 0.37; p = 0.04). Although receipt of AC was significantly associated with higher odds of positive margins (46% vs 23%; odds ratio = 2.85; p < 0.01), no difference in overall survival was detected between the AC and no AC cohorts (23% vs 19%; hazards ratio [HR] = 0.98; p = 0.91). Of note, independent of AC, PC was associated with improved survival compared to RC (51% vs 12%; HR = 0.25; p < 0.01). Conclusions: There is no detected survival benefit to the use of a non-standardized AC regimen in locally advanced bladder adenocarcinoma. Within the AC treated population, survival outcomes suggest that urachal subtype may confer survival advantage and that those patients selected for PC tend to have improved survival. Although employing a national dataset, statistical power was limited given the rarity of this disease. Further investigation is warranted on a larger scale in order to assess the impact of AC regimen, afford proper patient selection, and enhance risk stratification for oncologic outcomes.

Metastasis of clear cell renal cell carcinoma to the organs of the head and neck an ongoing problem

Renal cell carcinoma accounts for about 2-3% of all malignancies. It is characterized by a high frequency of metastases, which are most often observed in the lungs, bones, liver, brain and regional lymph nodes. Literature highlights the rare occurrence of renal cancer metastases to the head and neck, even though it is the third most common cancer that metastasizes to the head and neck.Below we present a case report of metastases of clear cell carcinoma from a kidney to the organs of the head and neck. The analysis was carried out retrospectively based on medical records of a patient hospitalized at the Department of Otorhinolaryngology, Head and Neck Surgery of the Medical University of Warsaw in the years 2009-2019. We describe an 81-year-old man after left-sided nephrectomy due to clear cell carcinoma, with numerous distant metastases, who was diagnosed with metastases to the left submandibular salivary gland 8 years after primary surgery, followed by a diagnosis of metastasis to the right submandibular salivary gland 3 years later. The patient underwent 2 radical procedures to remove the submandibular salivary glands. Due to the presence of lung metastases, treatment with a tyrosine kinase inhibitor was also implemented.

Clinical challenges in interpreting multiple pathogenic mutations in single patients

BackgroundIn the past two decades, genetic testing for cancer risk assessment has entered mainstream clinical practice due to the availability of low-cost panels of multiple cancer-associated genes. However, the clinical value of multiple-gene panels for cancer susceptibility is not well established, especially in cases where panel testing identifies more than one pathogenic variant. The risk for specific malignancies as a result of a mutated gene is complex and likely influenced by superimposed modifier variants and/or environmental effects. Recent data suggests that the combination of multiple pathogenic variants may be fewer than reported by chance, suggesting that some mutation combinations may be detrimental. Management of patients with “incidentally” discovered mutations can be particularly challenging, especially when established guidelines call for radical procedures (e.g. total gastrectomy in CDH1) in patients and families without a classic clinical history concerning for that cancer predisposition syndrome.Case presentationWe present two cases, one of an individual and one of a family, with multiple pathogenic mutations detected by multi-gene panel testing to highlight challenges practitioners face in counseling patients about pathogenic variants and determining preventive and therapeutic interventions.ConclusionsOngoing investigation is needed to improve our understanding of inherited susceptibility to disease in general and cancer predisposition syndromes, as this information has the potential to lead to the development of more precise and patient-specific counseling and surveillance strategies. The real-world adoption of new or improved technologies into clinical practice frequently requires medical decision-making in the absence of established understanding of gene-gene interactions. In the meantime, practitioners must be prepared to apply a rationale based on currently available knowledge to clinical decision-making. Current practice is evolving to rely heavily on clinical concordance with personal and family history in making specific therapeutic decisions.

Ag-Catalyzed Remote Unactivated C(sp3)-H Heteroarylation of Free Alcohols in Water.

Catalyzed by silver salt, the unactivated C(sp3)-H heteroarylation of free alcohol at the δ position is realized under gentle thermal conditions in water through a radical procedure. Both protonic acids and Lewis acids are found to be efficient for activating pyridines for this Minisci-type reaction. The reaction enjoys a good functional group tolerance and substrate scope. Terminal secondary and tertiary alcohols are suitable substrates. With either electron-donating or -withdrawing groups, the electron-deficient heteroarene substrates generate the target products in moderate to good yields. A gram-scale experiment can be successfully operated. A radical blocking experiment and a radical clock experiment are studied to support the radical mechanism.

Laparoscopic Radical and Conservative Surgery of Hydatid Liver Echinococcosis. PSM Based Comparative Analysis of Immediate and Long-term Outcomes

This study aimed to compare the immediate and long-term outcomes after laparoscopic radical and conservative cystectomies. Methods: HPB center (center 1) and general surgery hospital in endemic area (center 2) participated in retrospective study. Radical surgery included total, subtotal pericystectomy and liver resection. Conservative surgery comprised cystectomy without/with partial pericystectomy. Results: The total number of patients was 204. Laparoscopic cystectomy was performed in 97 (47%) patients. Radical (n-40) and conservative (n-61) laparoscopic procedures were performed in center 1 and center 2, respectively. Twenty-five pairs of patients were matched. The length of hospital stay and time of abdominal drainage were significantly shorter after radical surgery before and after PSM. The rate of severe morbidity did not differ. The mean follow-up length was 34 and 45 months in center 1 and center 2, respectively. No differences were found in the disease recurrence rate. Conclusion: Laparoscopic radical surgery leads to a reduction in the treatment time and can be recommended as the preferred treatment option in a specialized HPB center.

Survival and recurrence after radical and non-radical procedure in incidental and nonincidental gallbladder cancer patients

Survival and recurrence after radical and non-radical procedure in incidental and nonincidental gallbladder cancer patients

Meta-Analysis of Safety and Efficacy of Different Radical Gastrectomy in the Treatment of Gastric Cancer

To investigate the safety and efficacy of different radical gastric cancer treatments in the management of gastric cancer. The literature published in the last 5 y was searched for recent outcomes of different radical gastric cancer procedures used in the treatment of gastric cancer. 14 papers were finally included according to the established screening criteria. The trial design, study population characteristics and findings of the included studies were abstracted using randomized independent trials and statistically analyzed using RevMan 5.0 software. The results of the meta-analysis showed that laparoscopic early distal gastric cancer surgery compared with conventional open surgery: The operative time was 49.85 min longer (p<0.05), but intraoperative bleeding was 145.50 ml less (p<0.05), the number of postoperative analgesic requests was 1.22 less (p=0.01) and the number of days to the first postoperative vent was 0.57 d shorter (p<0.05), the number of days to the first postoperative meal was shortened by 0.88 d (p<0.05); the number of postoperative hospital days was shortened by 4.76 d (p<0.05) and the incidence of postoperative complications was low, both differences were statistically significant (p<0.05). The recent efficacy of laparoscopy-assisted distal gastrectomy in treating gastric cancer was significantly better than that of conventional open distal gastrectomy.

Inflammatory myofibroblastic tumor of the urinary bladder: treatment and a two-year monitoring - case report

Introduction. Inflammatory myofibroblastic tumor of the bladder or inflammatory pseudotumor is benign in nature. It is also known as a pseudotumor, because it macroscopically mimics infiltrative tumors of the bladder. The first inflammatory pseudotumor ever described was found in the lungs. In the 80s of the last century, it was first described in the urinary bladder. Its etiology is unknown and the incidence is extremely rare. Case Report. We present a case of a 46-year-old man who came to the Emergency Center for the first time due to an unpleasant feeling when urinating, painless hematuria and appearance of blood clots during urination. An urgent diagnosis revealed a tumor mass in the bladder. Additional diagnostics and surgical treatment was performed by transurethral electroresection of the urinary bladder. After the histopathological examination, an inflammatory myofibroblastic tumor of the bladder was diagnosed. The patient was discharged on the third day of admission. On control examinations, the patient underwent only cystoscopy and ultrasonography. No recurrences were observed. Conclusion. A review of the available literature showed that in such cases, after transurethral resection of bladder tumor, most urologists opted for more radical surgical procedures. After a two-year follow-up, we proved that a tumor of the bladder can be kept under control after transurethral resection of bladder tumor, without recurrence, by regular monitoring using ultrasonography and cystoscopy.

Postauricular Cutaneous Mastoid Fistula as Complication of Unsafe Type of Chronic Suppurative Otitis Media: a Case Report

Introduction: Postauricular cutaneous mastoid fistula (PCMF) is a very rare complication of chronic suppurative otitis media (CSOM). The fistula is typically challenging to manage due to necrotic skin edges. Case Report: This case report described a 53 years old female with PCMF as a complication of an unsafe type of CSOM and a history of diabetes mellitus who underwent a radical mastoidectomy procedure. After two days of post-operation, the patient was discharged from the hospital without any complication observed. The surgical scar was favourable in the fifth week after surgery. Conclusion: Radical mastoidectomy is an effective procedure to eradicate the disease as well as possible and also for the closure of PCMF.

Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement: ABRAX international retrospective cohort study.

The management of cervical cancer patients with intraoperative detection of lymph node involvement remains controversial. Since all these patients are referred for (chemo)radiation after the surgery, the key decision is whether radical hysterectomy should be completed as originally planned, taking into account an additional morbidity associated with extensive surgical dissection prior to adjuvant treatment. The ABRAX study investigated whether completing a radical uterine procedure is associated with an improved oncological outcome of such patients. We performed retrospective analyses of 515 cervical cancer patients (51 institutions, 19 countries) who were referred for primary curative surgery between 2005 and 2015 (stage IA-IIB, common tumour types) in whom lymph node involvement was detected intraoperatively. Patients were stratified according to whether the planned uterine surgery was completed (COMPL group, N=361) or abandoned (ABAND group, N=154) to compare progression-free survival. Definitive chemoradiation was given to 92.9% patients in the ABAND group and adjuvant (chemo)radiation or chemotherapy to 91.4% of patients in the COMPL group. The risks of recurrence (hazard ratio [HR] 1.154, 95% confidence intervals [CI] 0.799-1.666, P=0.45), pelvic recurrence (HR 0.836, 95% CI 0.458-1.523, P=0.56), or death (HR 1.064, 95% CI 0.690-1.641, P=0.78) were not significantly different between the two groups. No subgroup showed a survival benefit from completing radical hysterectomy. Disease-free survival reached 74% (381/515), with a median follow-up of 58 months. Prognostic factors were balanced between the two groups. FIGO stage and number of pelvic lymph nodes involved were significant prognostic factors in the whole study cohort. We showed that the completion of radical hysterectomy does not improve survival in patients with intraoperatively detected lymph node involvement, regardless of tumour size or histological type. If lymph node involvement is confirmed intraoperatively, abandoning uterine radical procedure should be considered, and the patient should be referred for definitive chemoradiation. NCT04037124.

إعادة هندسة العملیات وتأثیرها على التعلیم الجامعی «دراسة تطبیقیة على الجامعة المصریة»

إعادة هندسة العملیات وتأثیرها على التعلیم الجامعی «دراسة تطبیقیة على الجامعة المصریة»

Robotic TOTAL Pelvic Exenteration for Primary Carcinoma of Cervix, STAGE IV a

Study Objective This video is a demonstrates total pelvic exenteration done by robotic technique in a case of a primary cervical cancer at stage IV A. Design Case Report. Setting Semi-lithotomy position. Patients or Participants A 75-year old female complained of postmenopausal bleeding per vaginum, abdominal pain and constipation. In per speculum and on per vaginum examination, a circumferential growth was noted on the cervix, flushing the vagina with bleeding in touch. In per rectal examination, the growth was palpable and found to be extending to anterior rectal wall and lateral parametrium [stage IV A]. The cervical biopsy was suggestive of moderately differentiated squamous cell carcinoma. Interventions Total pelvic exenteration is a radical procedure which involves EN bloc resection of uterus, cervix, vagina, urinary bladder and rectosigmoid. It has been performed for primary and recurrent cervical cancer resulting in favourable outcomes. A thorough comprehension of pelvic anatomy helps in optimum tumor clearance. Any suspicion of distant metastasis us a contra-indication. Measurements and Main Results Following the surgery, a diversion ileostomy and cutaneous ureterostomy is created to drain the fecal matter and urine respectively to the exterior into a bag. Conclusion Robotic Total Pelvic Exenteration can be performed successfully in advanced cervical cancer.

Understanding Anterior Parametrectomy for Preventing Local and Pelvic Recurrences in Cervical Cancer - an Answer to Failure of LACC Trial

Study Objective This video is a demonstration of the anatomy of parametrium and its significance in radical hysterectomy in cervical cancer. Design Video Demonstration. Setting It includes a case of ca cervix stage IB undergoing nerve sparing radical hysterectomy with complete parametrectomy. The dissection of posterior and lateral parametrium is technically easier as compared to that of anterior parametrium. Anteriorly and posteriorly, protection to the spread of cervical cancer is provided by the cervico-vesical fascia and Denonvilliers fascia respectively. Deficiency or the weakest area facilitating tumor spread lies on the lateral aspects as the cervico- vesical ligaments and their incomplete removal leads to local and pelvic recurrences. Patients or Participants 60-year-old with post-menopausal bleeding & cervical biopsy squamous cell carcinoma. FIGO stage IB2. Interventions Understanding the anatomy of parametrium is an important step to achieve optimum tumor clearance. “Lymphatics follow the veins”, was the dictum that led to the origin for the need of parametrectomy in this radical procedure. Schematic diagrams depict the various extents of the parametrium in the three-dimensional scenario. The inferior vesical vein is ligated around two centimeters lateral to the lateral border of vagina making it the lateral extent on either side enforcing complete parametrial clearance. Meticulous and careful dissection of the ureter, achieving hemostasis and preserving the innervation were the various challenges encountered during the procedure. Laparoscopy with its magnified vision and a thorough knowledge of anatomy can achieve a complete parametrectomy. Measurements and Main Results Mean operative time 80 minutes. Blood loss 100ml. Conclusion Thus, this video makes an effort in understanding the anatomy of anterior parametrium. The failure to recognize it or incompetence to achieve it leads to higher rates of recurrences and lower survival rates in minimally invasive approach for cervical cancer as highlighted in the LACC trial.

Fertility- and Nerve-Sparing Laparoscopic Eradication of Deep Endometriosis with Anterior and Posterior Compartment Peritonectomy

Study Objective To show anatomical and technical highlights of novel nerve-sparing laparoscopic eradication of deep endometriosis (DE) with anterior and posterior compartment peritonectomy. Design Stepwise demonstration of the technique. Setting An urban general hospital. Laparoscopic nerve-sparing techniques represented by the Negrar method have been described as resulting in lower rates of postoperative bladder, rectal, and sexual dysfunctions than classical approaches. In addition, a recent paper showed that complete excision of DE with the posterior compartment peritonectomy could be surgical treatment of choice to decrease postoperative pain, improve fertility rate, and prevent future recurrence. However, a fertility- and nerve-sparing procedures are even more challenging than oncologic radical procedures because the pathology resembles advanced cervical cancer and ovarian cancer. Patients or Participants N/A Interventions After adhesiolysis and ovarian surgery, we developed retroperitoneal space at the level of promontory. The hypogastric nerve consists of the upper edge of pelvic plexus, so autonomic nerves were separated as a “nerve plane“ by sharp interfascial dissection of the loose connective tissue layers both above (between fascia propria of rectum and prehypogastric nerve fascia) and below (between prehypogastric nerve fascia and presacral fascia) the hypogastric nerve. As a result of these dissections, autonomic nerves in pelvis were separated like a sheet with surrounding fascia. We then completely resected all DE lesions including peritoneal endometriosis while avoiding injury to the nerve plane. Measurements and Main Results No patients (n=40) developed postoperative bladder, rectal, and sexual dysfunctions after the surgery. This nerve-sparing method is a modification of the technique of total mesorectal excision (TME) and total mesometrial resection (TMMR). We considered that this nerve-sparing technique is also applicable to segmental bowel resection and radical hysterectomy. Conclusion Our novel nerve-sparing surgery based on detailed meso-anatomy reproducibly simplify this complex procedure. Step-by-step technique help to perform each part of the surgery in a logical sequence, making the procedure easier and safer to complete.

Salvage surgery for stage IVa thymic carcinoma combined with aortic arch resection \u2013 case report

BackgroundAlthough complete surgical resection of thymic carcinoma is a prognostic factor, extended surgery combined with a major blood vessel procedure remains controversial because of the increased risk of mortality. We report a case of Stage IVa thymic carcinoma successfully resected with a pneumonectomy along with aortic arch replacement after chemotherapy.Case presentationA 45-year-old male was diagnosed with thymic carcinoma invasion to the aortic arch and left pulmonary artery. Malignant pericardial effusion was also noted, though disappeared after chemotherapy, thus surgical options were considered. A radical resection procedure including left pneumonectomy, aortic arch replacement with total rerouting of the supra-arch vessels, and right pulmonary artery plication was performed. The postoperative course was uneventful and the patient has been disease-free for 3 years.ConclusionExtended salvage surgery might be a valuable option for advanced thymic carcinoma.

Multivisceral resection for locally advanced gastric cancer: A retrospective study

BackgroundMultivisceral resection may be the exclusive radical procedure for cT4b gastric cancer patients. However, most surgeons refuse to select surgery because of the theoretical higher mortality, morbidity and poorer prognosis. MethodsWe retrospectively reviewed cT4b gastric cancer patients who underwent surgery from January 1,1997 to December 31,2018. The primary endpoint was overall survival. Short-term results and prognostic values of clinical and pathologic factors were also analyzed. ResultsPatients underwent multivisceral resection had an acceptable mortality and morbidity. The overall 5-year survival rate of multivisceral resection was higher than that of palliative surgery (P < 0.05). And independent prognostic factors of multivisceral resection were R+ resection, extensive lymph node involved (>15), vascular cancer emboli, and postoperative chemotherapy.Conclusions: cT4b gastric cancer patients underwent multivisceral resection experience acceptable mortality and morbidity. The independent prognostic factors for multivisceral resection were completeness of resection, extensive lymph node involvement (>15), vascular cancer emboli, and postoperative chemotherapy.

Radical Surgical Procedures in Advanced Ovarian Cancer and Differences Between Primary and Interval Debulking Surgery.

We aimed to identify differences in cytoreduction rates and procedures performed in patients with advanced ovarian cancer undergoing primary (PDS) or interval debulking surgery (IDS). Data were collected prospectively on 110 consecutive patients from June 2016 to Mar 2020. Forty-nine patients (44.5%) underwent diaphragmatic peritonectomy (34 in PDS and 15 in IDS, p=0.005), while 38 (34.5%) underwent large bowel resection (29 in PDS and 9 in IDS, p<0.001). Complete cytoreduction was achieved in 39 patients in PDS and 29 in IDS (65% vs. 58%, p=0.22). Longer operations with more blood loss and extended hospital stay were performed in the PDS group. Ten patients (9.1%) experienced severe complications and in eight patients (7.2%) chemotherapy was delayed. More bowel resections and diaphragmatic stripping were performed in the PDS group. End surgical results were similar between groups, with a trend for more complete cytoreduction in PDS.

Synthesis of poly (hydroxamic acid) ligand for removal of Cu (II) and Fe (II) ions in a single component aqueous solution

Biosorbents are the alternatives for the removal of heavy metals because they are cheaper and more effective. This is attributed to the metallic elements interactions with the functional groups on the surface of the adsorbent. Additionally, the surface of biosorbents can further be improved by pretreatment and modification leading to the formation of functional derivatives onto the cellulose backbone. In this study pine cone powder was pretreated using Fenton reagent and modified by grafting with acrylic acid in order to enhance structural characteristics of the material. Grafting of acrylic acid onto Fenton treated pine cone powder was achieved by a free radical procedure in which ceric ammonium nitrate (CAN) was used as an initiator. Furthermore, a new poly (hydroxamic acid) ligand was synthesized from the poly(acrylic acid) grafted pine cone powder for heavy metal ions removal from aqueous media. The observed FTIR bands that shifted from 1727 cm−1 shifted to 1616 cm−1 confirmed that ester functional groups were converted to hydroxamic acid groups, which was further confirmed by elemental analysis results. The poly (hydroxamic acid) ligand was further characterized by TGA/DTA, XRD, SEM-EDS techniques. The TGA/DTA results revealed that the poly(acrylic acid) grafted pine cone powder had better thermal stability. The XRD spectra revealed that the structure of pine cone powder is composed mainly of crystalline cellulose. The SEM results indicated that the grafted pine cone powder showed a smooth surface, which is an indication that the acrylic acid was coated on the surface of the Fenton treated pine cone powder. It further revealed a coarse surface the poly (hydroxamic acid) ligand confirming the conversion of the carboxyl group to hydroxamic acid group. The linear Langmuir isotherm plot gave an R2 values of 0.9997 for Cu (II), 0.9961 Fe (II) biosorption while Freundlich isotherm plot R2 values were 0.9581 for Cu(II) and 0.9671 Fe (II) biosorption. These results demonstrate that the Freundlich isotherm was not a good fit to describe the process of adsorbed metal ions and their equilibrium concentration in solution. The theoretical values qe (mg g−1) of the pseudo second order model compared with those for the pseudo first order kinetic model agree with the experimental value qe (mg g−1). Therefore, these results confirm the chemisorption of Cu (II) and Fe (II) onto poly (hydroxamic acid) ligand.

LARGE ODONTOGENIC INFLAMMATORY CYST ASSOCIATED WITH IMPACTED TEETH: DIAGNOSIS AND TREATMENT

Radicular cysts are defined as a cavity lined by epithelium and with development related to an inflammatory stimulus. We will approach, through a clinical case report, the method of diagnostic evaluation based on histopathologic criteria, as well as the surgical treatment choice of an inflammatory cyst with clinical characteristics of aggressive lesions. A male patient with an intra-osseous lesion associated with impacted teeth was evaluated. Due to the extension of the lesion, 2 surgical stages were chosen. At the first moment, aspiration, marsupialization, and incisional biopsy were performed. The result was compatible with a radicular cyst. In the second surgical stage, the cyst was enucleated and elements 37 and 38 removed, and intermaxillary block was performed with the purpose of preventing jaw fracture. The material was sent to histopathology study, with a final diagnosis of inflammatory cyst. Especially in extensive lesions, the definitive diagnosis must be made before performing more radical surgical procedures.