8 minute read
Oral and Maxillofacial Pathology Case of the Month
The second, and less obvious, way to develop a team is to encourage them to think and act both independently and interdependently. This is referred to as “vertical development” and involves the development of the individual and team’s mental capacity and skill set. Developing a team’s capability to think and act both independently and interdependently, and understanding the distinction and value of each, is foundational to achieving peak performance.
Consider this: If we insist on making every decision in our practice, we become an unnecessary bottleneck and we are unknowingly undermining our team’s ability to reach peak performance. Many of the non-clinical decisions can and should be made by our team.
By allowing team members to think and act within predetermined guidelines, we are taking these burdens off our plate, removing unnecessary barriers to efficiency, and promoting individual and team confidence and growth. What is important is that each team member has the support and authority to act independently while considering the impact of their decisions on the entire team. This is when interdependent thinking, often requiring collaboration with other team members, is most important and most valuable.
Simple coaching skill sets can be very effective in creating peak performing teams. Michael Bungay Stanier has written 2 excellent books that teach useful coaching skills for anyone wanting to take their team to higher levels of performance. Stanier’s first book, The Coaching Habit, presents 7 simple coaching questions that doctors will find invaluable when attempting to improve individual and team performance. His second book, The Advice Trap, serves as a primer for individual and team vertical development. Anyone interested in developing these vital skill sets should make it a point to read both books.
REFLECTION
One of the best and most effective ways to achieve peak performance is through reflection. At the end of each day or the beginning of the next day, take a few minutes to reflect on the previous day. What went right? What could have been improved and why? What was a barrier to achieving peak performance?
Again, using simple coaching skills and language will remove the team’s fear of offering an honest and unfiltered selfappraisal. These few minutes will prove to be one of the best team building techniques and doctors will begin to see the staff improve their level of performance faster than they ever thought possible.
In summary, becoming more coach-like does not require rigorous training or certification. Anyone can learn simple skill sets that will prove invaluable in moving their organization to higher levels of productivity and profitability. More importantly, coaching your team is arguably the best way to sustain peak performance while simultaneously building an optimal practice culture. For more information, read Michael Stanier’s books. You will be very glad that you did.
ORALand maxillofacial pathology case of the month
Clinical History
AUTHORS
A 60-year-old African American female was referred to an oral surgeon (S.A.S.) for evaluation of an asymptomatic left posterior mandibular lesion. Her medical history was significant for anxiety, HIV, hypoglycemia, and osteoarthritis. A prior history of right hip replacement in 2015 and left shoulder replacement in 2016 was also disclosed. Her medications included emtricitabine, dipivefrine, and tenofovir alafenamide (Odefsey) to manage her HIV and hydrocodone bitartrate/acetaminophen (Norco 7.5) to alleviate chronic pain related to her previous surgeries. She reported a 35 pack-year history of smoking cigarettes (3/4 packs per day for 47 years) and denied alcohol consumption.
Victoria L. Woo, DDS
Clinical Professor of Oral Pathology, Department of Diagnostic Sciences, College of Dentistry, Texas A&M University, Dallas, TX
Brandon J. Saxe, BS, DMD
Oral and Maxillofacial Surgery Resident Denver Health Medical Center, Denver, CO
Allison M. Lee, DDS
Oral and Maxillofacial Pathology Resident, College of Dentistry, Texas A&M University, Dallas, TX
Steven A. Saxe, DMD
Visiting Professor of Clinical Sciences School of Dental Medicine, University of Las Vegas, Nevada, Las Vegas, NV
Disclosures: There are no financial, economic, or professional interest disclosures for this study.
Figure 1. Initial panoramic radiograph showing a unilocular radiolucency with well-defined, corticated borders involving the left posterior mandible and ramus. The lesion was causing inferior and medial displacement of tooth #17.
Figure 2. A cone-beam computed tomography scan depicts mild thinning of the left mandibular buccal and lingual cortices with no significant expansion or perforation. (Axial view).
Intraoral examination revealed normal-appearing gingival mucosa distal to the left mandibular second molar without associated alveolar ridge swelling or expansion. No complaints of pain were elicited on palpation of the area. A panoramic radiograph showed a well-defined, corticated radiolucency with scalloped borders pericoronal to an impacted and inferiorly displaced left mandibular third molar (Figure 1). The lesion extended from the distal root of the left mandibular second molar to the coronoid notch. A cone-beam computed tomography (CBCT) scan with 3D reconstruction confirmed mild thinning of the buccal and lingual cortices (Figure 2) with no evidence of continuity defects or perforations.
Preoperative laboratory evaluation consisted of a complete blood count with differential, HIV viral load, prothrombin time, partial prothrombin time, chest X-ray, and ECG. All values were within normal limits, and HIV-1 was undetectable via polymerase chain reaction analysis.
Following a negative aspiration, a full-thickness mucoperiosteal flap was raised, and a surgical fenestration was created in the left mandibular ramus region. A white, fibrous mass surrounding a cystic lumen was exposed and carefully enucleated, yielding a specimen of approximately 2cm in greatest dimension. The impacted third molar was identified at the most inferior aspect of the bony crypt and extracted without complication.
Pathologic Findings
Histopathologic examination revealed a cyst lined by predominately thin stratified squamous epithelium with focal epithelial spheres and papillary projections (“tufts”) (Figure 3A — see next page). In some areas, the luminal epithelium was composed of a single layer of cuboidal eosinophilic cells exhibiting cilia and a mildly hobnailed configuration (Figure 3B). Mucous cells, clear cells, and intraepithelial microcysts were also identified (Figures 3C and D).
The patient was seen for reevaluation at 2 weeks and again at 6 months post-operatively with no evidence of recurrence. A panoramic radiograph taken at the 6-month visit showed progressive bone fill of the surgical site (Figure 4).
What is the most likely diagnosis? See page 464 for the answer and discussion.
ORALand maxillofacial pathology, continued
A B
C D
Figure 3. Histopathologic examination of the enucleated specimen revealed variably thickened stratified squamous cyst lining with epithelial spheres and a papillary projection (A); lightly eosinophilic luminal cells, some exhibiting surface cilia and hobnailing (B); numerous mucous cells (C); and intraepithelial microcysts (D). (A, hematoxylin and eosin [H&E], original magnification x 100; B, H&E, x 200; C, H&E, x 100; D, H&E, x 100).
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