A 13-year-old patient who consulted for a lumbar pain in June 2004 presented with a localized uptake image in the right upper jaw on scintigraphy.
The patient denied a history of disease, and the examination showed no intra or extraoral symptoms suggestive of disease.
Orthopantomography showed an apical radiopaque image on the first and second upper right premolar.
Diagnostic confirmation CT showed a ground glass image compatible with fibrous dysplasia of the right upper jaw.
The definitive diagnosis was made by biopsy of the affected area.
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The patient, asymptomatic, is periodically reviewed, and in September 2004 begins with discomfort to chewing hard foods.
The examination showed a bulging of the right vestibule and palate and redness of the lining mucosa, without increasing tooth mobility.
Surgery is proposed with the intention of complete resection of the lesion.
In the preoperative study, laboratory tests detected an alteration in coagulation parameters.
After confirmation, a Pathologist diagnosed mild factor XI deficiency (heterozygous) and normocytic normochromatic anemia.
The patient underwent surgery in February 2005 under general anesthesia and required a preoperative preparation.
The patient is prepared to receive tranexamic acid during the week prior to the intervention.
A coagulation study was performed 12 hours before surgery, and all values were within normal limits.
It is prescribed to transfuse two units of fresh plasma thirty minutes before surgery.
A right hemimaxillectomy was performed, removing from the maxillary tuberosity to the first premolar, and palatal bone, leaving the orbital floor.
He was successfully treated without complications in the immediate postoperative period.
During the postoperative period, tranexamic acid and coagulation analytical controls were maintained for seven days.
The patient was discharged after 10 days without complications and without signs of bleeding.
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In the early postoperative period she presents pain in the infraorbital nerve territory and unresolved anemia.
In June 2005, neuralgia disappeared and prosthetic rehabilitation was performed using a removable partial prosthesis, without presenting problems or signs of recurrence.
In August 2005, the patient had a recurrence in the right malar region and was asymptomatic.
It begins with localized pain in this area one month later.
The use of bisphosphonates to treat pain is proposed as a treatment option.
