On Monday 13th Feb I bit my sandwich and felt as though the waiter had whacked me in the side of the jaw with the sharp end of a skillet. I couldn’t open my eyes for the pain, but when I did I was alone except for the searing jabbing sensation that persisted in my left side. I thought it was a bad wisdom tooth, little did I know that I had a dental condition which afflicts 1 in 5 million people. Within a few days I had an appointment Chung Ming Tse, Dentist and Prosthodontist at Beijing United Family Hospital. Dr Tse was comforting but his manner betrayed an underlying concern. To my untrained eye the x-ray appeared to show the source of the pain to be a sunken wisdom tooth. Dr Tse gently suggested a CT scan after pointing out the lack of structure around the left jaw from the molars to the hinge. The 3-D images of the skull led to Dr Tse asking the nurses to leave the room and for the first time in my life I felt that sense of fear of the medical unknown. He pointed out the lack of extensive lack bone structure on the left side of my lower jaw, the mandible, and in a very caring manner gave me the sense that this condition needed urgent attention as the bone had become very thin and would eventually fracture. 
The following 24 hours were spent in a state of denial, shock and a sense of purpose. The near constant aching pain which I had tolerated in my lower jaw for several years was caused by an ameloblastoma; a rare, highly destructive, benign, rapidly growing tumor of the jaw. 
‘ameloblastoma /am·e·lo·blas·to·ma/ (-blas-to´mah) a usually benign but locally invasive neoplasm of tissue of the type characteristic of the enamel organ, but which does not differentiate to the point of enamel formation.’ The importance of the correct classification via histopathologic exam became clear to me later as I searched for a solution. Ameloblastomas are classified as solid/multicystic, classical intraosseous; peripheral; or unicystic sybtypes. The prevalent treatment on the internet is that of replacement of the mandible to a margin wide enough to ensure that the surrounding areas will not allow recurrence. Recurrence is common, upto 70%, and in some cases fatal. On the Sat 18 th Feb I visited Dr Tse at BJU to view the CT scans. Dr Tse and Dr Zhang, his colleage told me that the treatment is one of a segmental resection of the mandible , taking bone from the tibia. An operation which could be conducted by a University of Peking Maxillofacial surgeon the following week. This 8 hour operation would require a week in hospital and several months recuperation. My face, and leg, would not be the same again. Dr Tse patiently talked me through the options and benefits of being closer to home in Beijing, but also shared that the technical skills in China were hard to compare with this in Singapore. At this stage my lack of medical insurance preyed on my mind, but was a secondary consideration with the Peking University Hospital option costing approximately RMB60,000. The 3D Image gave me a new look at my dental condition. The Ameloblastoma has expanded along the lower jaw exposing that painful molar, and upto toward the hinge. The slight tingling sensation in my cheek, and feeling that I was drooling from the left corner of my mouth was explained as the pressure and potential disruption to the nerve. I would apparently not lose control, but potentially the sensation from parts of my left cheek. Any questions about timing of my treatment were answered in the picture. 
I have always had great faith in Singapore and the quality of the medical expertise. Statistically the Republic with a population of 4.5m may not even have cases of Ameloblastoma which affects 0.18 males in 1 million. By a miracle of the advanced search function on google, before going to the BJU on the Saturday morning I had found Professor Ho Kee Hai, Oral and Maxillofacial Surgeon. I had used my iphone to take screen shots of the CT scans and emailed them to Professor Ho. Within an hour he took the time to talk with Dr Tse. He then told me that he has an alternative, “conservative method,” to tackling the tumor. It was all conditional upon which type of Ameloblastoma which required a biopsy. I booked a Singapore Airlines flight and was in his office at 0900 on Monday 20th. Professor Ho operates an eponymous clinic, Ho Kee Hai and Partners Dental Implant Maxillofacial Aesthetic Centre at the Paragon Medical Centre, and but few a couple of obscure references within user groups and specialist medical papers, one would never know that he has been operating on Ameloblastoma’s for over 30 years. A patrician gentlemen who immediately made me feel comfortable, Professor Ho showed me cases from a 157 slide power point presentation made to The 9th Asian Congress on Oral & Maxillfacial Surgery ( ACOMS) held in Malaysia in 2011. Essentially the “conservative approach” is to extract the tumor and to leave the wound dressed, but open. The wound dressing allows nature to take its course. They pack the cavity with an equivalent of WhiteHead Varnish; gum benzoin, 4 parts; styrax, 3 parts ; balsam tolu, 1 part; ether, 40 parts ; with the addition of 10 per cent iodoform. All five constituent drugs are antiseptic when used. Apparently the British WhiteHead Varnish was excellent and it's disappearance confounded Professor Ho who had to replace it with a French equivalent. The bone repairs and expurgates the tumor. This is possible with certain types of Ameloblastoma. Professor Ho was hopeful having seen the nature of the cavity from his own 3-D X-ray, but performed a biopsy on Monday 20 th. 
Today the results came back from Quest Laboratories. I went in to see Professor Ho. This would decide the likely success of the conservative approach, or being forced into taking the more conventional resection. The report reads, ‘fragments of lamellar bone and fibrous tissue, covered in …stratified squamous epithelium featuring peripheral palisading of elongated columnar cells, with a suggestion of reversed polarity…Features are suggestive of a cystic ameloblastoma.’ Professor Ho kindly shared the report with me, but for my part it could have been Mandarin, but his reassuring smile was all the answer that I needed. We could proceed with the “conservative approach.” The reason that the majority of procedures are ‘replacement of mandible’ is because the belief is that the tumor behaves like a cancer and must be eradicated by a wide margin. Apparently some strains of tumor penetrate into the bone, but I am fortunate in that my ameloblastoma has been “expansionary” in nature; it has grown along the jaw cavity rather than into the bone matter. I have been cautioned that I may lose some nerve sensation in the left cheek and left side of the tongue; but this still seems a great deal better than mandible replacement and bone graft. I have faith that my body will heal the cavity created by the surgery on Saturday. Years ago I read a book by Dr Andrew Weil a practitioner and teacher of integrative medicine for the last thirty years, entitled "Spontaneous Healing." The book talks to the bodies natural desire to heal given our support with the proper nutrition, exercise and spiritual care. I believe in his philosophy, and found in Professor Ho a practitioner who does too. All I can do now is to entrust myself to Professor Ho, the nurses at Mount Elizabeth Hospital, and the healing processes of nature.
The following 24 hours were spent in a state of denial, shock and a sense of purpose. The near constant aching pain which I had tolerated in my lower jaw for several years was caused by an ameloblastoma; a rare, highly destructive, benign, rapidly growing tumor of the jaw. ‘ameloblastoma /am·e·lo·blas·to·ma/ (-blas-to´mah) a usually benign but locally invasive neoplasm of tissue of the type characteristic of the enamel organ, but which does not differentiate to the point of enamel formation.’ The importance of the correct classification via histopathologic exam became clear to me later as I searched for a solution. Ameloblastomas are classified as solid/multicystic, classical intraosseous; peripheral; or unicystic sybtypes. The prevalent treatment on the internet is that of replacement of the mandible to a margin wide enough to ensure that the surrounding areas will not allow recurrence. Recurrence is common, upto 70%, and in some cases fatal. On the Sat 18 th Feb I visited Dr Tse at BJU to view the CT scans. Dr Tse and Dr Zhang, his colleage told me that the treatment is one of a segmental resection of the mandible , taking bone from the tibia. An operation which could be conducted by a University of Peking Maxillofacial surgeon the following week. This 8 hour operation would require a week in hospital and several months recuperation. My face, and leg, would not be the same again. Dr Tse patiently talked me through the options and benefits of being closer to home in Beijing, but also shared that the technical skills in China were hard to compare with this in Singapore. At this stage my lack of medical insurance preyed on my mind, but was a secondary consideration with the Peking University Hospital option costing approximately RMB60,000. The 3D Image gave me a new look at my dental condition. The Ameloblastoma has expanded along the lower jaw exposing that painful molar, and upto toward the hinge. The slight tingling sensation in my cheek, and feeling that I was drooling from the left corner of my mouth was explained as the pressure and potential disruption to the nerve. I would apparently not lose control, but potentially the sensation from parts of my left cheek. Any questions about timing of my treatment were answered in the picture. I have always had great faith in Singapore and the quality of the medical expertise. Statistically the Republic with a population of 4.5m may not even have cases of Ameloblastoma which affects 0.18 males in 1 million. By a miracle of the advanced search function on google, before going to the BJU on the Saturday morning I had found Professor Ho Kee Hai, Oral and Maxillofacial Surgeon. I had used my iphone to take screen shots of the CT scans and emailed them to Professor Ho. Within an hour he took the time to talk with Dr Tse. He then told me that he has an alternative, “conservative method,” to tackling the tumor. It was all conditional upon which type of Ameloblastoma which required a biopsy. I booked a Singapore Airlines flight and was in his office at 0900 on Monday 20th. Professor Ho operates an eponymous clinic, Ho Kee Hai and Partners Dental Implant Maxillofacial Aesthetic Centre at the Paragon Medical Centre, and but few a couple of obscure references within user groups and specialist medical papers, one would never know that he has been operating on Ameloblastoma’s for over 30 years. A patrician gentlemen who immediately made me feel comfortable, Professor Ho showed me cases from a 157 slide power point presentation made to The 9th Asian Congress on Oral & Maxillfacial Surgery ( ACOMS) held in Malaysia in 2011. Essentially the “conservative approach” is to extract the tumor and to leave the wound dressed, but open. The wound dressing allows nature to take its course. They pack the cavity with an equivalent of WhiteHead Varnish; gum benzoin, 4 parts; styrax, 3 parts ; balsam tolu, 1 part; ether, 40 parts ; with the addition of 10 per cent iodoform. All five constituent drugs are antiseptic when used. Apparently the British WhiteHead Varnish was excellent and it's disappearance confounded Professor Ho who had to replace it with a French equivalent. The bone repairs and expurgates the tumor. This is possible with certain types of Ameloblastoma. Professor Ho was hopeful having seen the nature of the cavity from his own 3-D X-ray, but performed a biopsy on Monday 20 th. Today the results came back from Quest Laboratories. I went in to see Professor Ho. This would decide the likely success of the conservative approach, or being forced into taking the more conventional resection. The report reads, ‘fragments of lamellar bone and fibrous tissue, covered in …stratified squamous epithelium featuring peripheral palisading of elongated columnar cells, with a suggestion of reversed polarity…Features are suggestive of a cystic ameloblastoma.’ Professor Ho kindly shared the report with me, but for my part it could have been Mandarin, but his reassuring smile was all the answer that I needed. We could proceed with the “conservative approach.” The reason that the majority of procedures are ‘replacement of mandible’ is because the belief is that the tumor behaves like a cancer and must be eradicated by a wide margin. Apparently some strains of tumor penetrate into the bone, but I am fortunate in that my ameloblastoma has been “expansionary” in nature; it has grown along the jaw cavity rather than into the bone matter. I have been cautioned that I may lose some nerve sensation in the left cheek and left side of the tongue; but this still seems a great deal better than mandible replacement and bone graft. I have faith that my body will heal the cavity created by the surgery on Saturday. Years ago I read a book by Dr Andrew Weil a practitioner and teacher of integrative medicine for the last thirty years, entitled "Spontaneous Healing." The book talks to the bodies natural desire to heal given our support with the proper nutrition, exercise and spiritual care. I believe in his philosophy, and found in Professor Ho a practitioner who does too. All I can do now is to entrust myself to Professor Ho, the nurses at Mount Elizabeth Hospital, and the healing processes of nature. 