Someone mentioned on DT that I left the patients name in the left corner. Willie was aware that I was posting this on several sites looking for an answer and I was given permission to use his name. He wants to know as much as anyone and doesn't give rip about his name. I'm very pleased with the rapid response from Susan at Emory and will attempt to get Willie there. Guy
--This is the answer I got from an oral pathologist at Emory if any are interested.
Guy W. Moorman, Jr., D.D.S.
The Swamp
Douglas, GA 31533
This email message and any attached files are confidential and are intended solely for the use of the addressee(s) named above. This communication may contain material protected by patient rights, work product, or other privileges. If you are not an intended recepient, you have received this communication in error and any review, use, dissemination, forwarding, printing, copying, or other distribution of this email message and any attached files is strictly prohibited. If you have received the confidential message in error, please notify the sender immediately by reply email message and permanently delete the original message.
From: Muller, Susan [mailto:smull01@emory.edu]
Sent: Wednesday, January 30, 2013 3:04 PM
To: Guy Moorman
Subject: RE: Lesion in mandible area of apex of 19 roots
Hi Guy: Based on the panorex this looks like florid cemento-osseous dysplasia (FCOD). These lesions have been reported to develop osteomyelitis due to the poor blood supply in the presence of infection/trauma. That is maybe what your patient is experiencing. If you notice, there is an area of radiolucency around apex of 19. Sometimes traumatic bone cyst can develop in conjunction with FCOD. We usually try and not muck with FCOD to prevent osteomyelitis, but once present it needs to be treated. I would recommend our OMFS here. He may need more sophisticated imaging to give a 3D image of the area.
Susan
Susan Muller, DMD, MS
Professor
Department of Pathology and Laboratory Medicine
Department of Otolaryngology Head and Neck Surgery
Winship Cancer Institute
Emory University School of Medicine
Atlanta, GA
404-712-1018
404-686-4978 FAX
From: Guy Moorman [gmoor@windstream.net]
Sent: Wednesday, January 30, 2013 1:53 PM
To: Muller, Susan
Subject: Lesion in mandible area of apex of 19 rootsSusan, I knew Ronnie well and hear that you are more than an able replacement. I am trying to make a decision here on referral. We use the Emory ENT department a great deal. Bill Grist has done several surgeries for us and the OMFS department one major case. We obviously could send this to a nearby OMFS for a biopsy but if it looks like it is going to be more than that, we'd like to go ahead and get him to Emory if his insurance covers Emory. Our group prefers Emory, maybe because I'm a 69 grad of the dental school and also very aware of the quality of your department.
This is 50 year old black man who has been a long term but infrequent patient. A necrotic and extremely painful 19 got him in to me for endo, which I have performed. Not my best endo but functional…long on distal and mesial POE were a delta and impossible to operate. Still the concern is the lesion at the apex of 19s roots. We had an old panorex from 2002 when we were shooting everyone who walked in because we were behind due to the lack of pan until then. We are now digital and the quality has improved. It appears that the lesion was present in 2002 but is now larger. It could be an ossifying lesion from a long time periapical lesion or something else. Should be send him on to Emory or let a local OMFS do a biopsy. We have excellent OMFSs in Valdosta but this is near the IAN and I want him to get the best possible treatment. Sincerely, Guy Moorman DDS
Guy W. Moorman, Jr., D.D.S.
P.O. Box 1268
The Swamp
Douglas, GA 31534
This email message and any attached files are confidential and are intended solely for the use of the addressee(s) named above. This communication may contain material protected by patient rights, work product, or other privileges. If you are not an intended recepient, you have received this communication in error and any review, use, dissemination, forwarding, printing, copying, or other distribution of this email message and any attached files is strictly prohibited. If you have received the confidential message in error, please notify the sender immediately by reply email message and permanently delete the original message.
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Guy W. Moorman
The Swamp
Douglas, Georgia --
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