Management of Recurrence of Ameloblastoma and Odontogenic Keratocyst: A Cross-Sectional Study / Manejo de la recurrencia del ameloblastoma y keratoquiste odontogénico: Estudio de corte transversal

Abstract Objectives: Odontogenic keratocyst (OKC) and ameloblastoma are slowly growing and locally invasive tumors with high recurrence rate. The aim of this study was to investigate the clinicopathologic features of recurrent ameloblastoma and OKC cases, and evaluate outcomes of our treatments in terms of recurrence. Material and Methods: A total of 23 patients with confirmed recurrent ameloblastoma or OKC and treated in our clinic within eleven years period were reviewed retrospectively. Results: Eleven recurrent OKC cases and twelve recurrent ameloblastoma cases were included. Most recurrences occurred within five years after the initial treatment (69.6%). Enucleation had the highest recurrence rate among the first treatments (18/23). All recurrences were located in the mandible, with one exception (22/23). All recurrent OKCs were multilocular. Different histopathologic subtypes of ameloblastoma were seen in our study, follicular ameloblastoma was the most common (8/12). The mean diameter of the lesions was 4.3 cm (ranging from 2 cm to 7 cm). Statically significant relation was found between location and diameter of lesion and year of recurrence onset (p=0.004; p=0.026). We performed radical treatments in these cases (ten patients underwent marginal resections, and thirteen patients underwent segmental resection), and no recurrence was observed during the follow-up period. Conclusion: Previous inadequate surgical procedures were the most important cause of recurrence. Marginal or segmental resection with safety margins is the best method to treat recurrences of OKC or ameloblastoma cases.

Resumen Objetivo: Los keratoquistes odontogénicos (KQO) y ameloblastomas son tumores invasivos de lento crecimiento local con una alta tasa de recurrencia. El propósito de este estudio fue investigar las características clínico patológicas de los casos de ameloblastoma y KQO recurrentes y evaluar los resultados de tratamientos en término de recurrencia. Materiales y Métodos: Un total de 23 pacientes con casos confirmados de ameloblastomas o KQO recurrentes tratados en nuestra clínica en un período de once años fueron incluidos. Resultados: Once casos de KQO recurrentes y doce ameloblastomas recurrentes fueron incluidos. La mayoría de las recurrencias ocurrieron en los primeros 5 años posteriores al tratamiento inicial (69.6%). La enucleación mostró la tasa de recurrencia más alta entre los tratamientos iniciales (18/23). Todas las recurrencias se presentaron en la mandíbula excepto por un caso (22/23). Todos los KQO fueron multiloculares. Distintos subtipos histológicos del ameloblastoma fueron detectados en el estudio y el ameloblastoma folicular fue el más común (8/12). El diámetro promedio de las lesiones fue de 4.3cm en un rango de 2cm a 7cm. Una relación estadísticamente significativa se encontró entre la ubicación y el diámetro de la lesión y el tiempo de aparición de la recurrencia (p=0.004; p=0.026). Se realizaron tratamientos radicales en los siguientes casos, diez pacientes tuvieron resecciones marginales y trece pacientes resección segmental; no se observaron recurrencias en el período de seguimiento. Conclusión: Procedimientos previos inadecuados fueron la causa más relevante de recurrencia. Resección marginal o segmental con márgenes de seguridad son el mejor método para tratar casos de ameloblastoma y KQO recurrentes.

Short term histopathological effects of GaAlAs laser on experimentally induced TMJ osteoarthritis in rabbits

Abstract The aim of this study was to evaluate the biostimulation (BS) effect of the gallium-aluminum-arsenide (GaAlAs) diode laser by histopathology with an experimental osteoarthritis (OA) model in the temporomandibular joints (TMJ) of rabbits, in the early period. GaAlAs diode laser is used for pain reduction in TMJ disorders. Twenty-four adult male New Zealand white rabbits were randomly divided into three equal groups: Control Group (CG), Study Group 1 (SG-1), and Study Group 2 (SG-2). Mono-iodoacetate (MIA) was administered to the right TMJs of all rabbits. The rabbits did not undergo any treatment for four weeks to allow the development of osteoarthritis. In SG-1, laser BS was applied to the rabbits at 940 nm, 5 W, and 15 J/cm2 in continuous wave mode at 48-hour intervals for 14 sessions; and in SG-2, laser BS was applied with the same parameters at 24-hour intervals for 28 sessions. Laser BS was not applied to the rabbits in CG. All rabbits were sacrificed simultaneously. The TMJ cartilage, osteochondral junction, chondrocyte appearance, and subchondral ossification were evaluated histopathologically. There was no statistically significant difference between the groups in terms of cartilage, osteochondral junction, chondrocyte appearance, and subchondral ossification values (p > 0.05). The laser BS protocol used in the study had no positive histopathological effects on TMJ OA in the early period.