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Ameloblastoma is a benign, locally aggressive neoplasm that constitutes about 1–3% of the tumors of the jaw. Wide surgical excision with adequate safe margin is the most common treatment of choice. The study aimed to manage cases with unicystic ameloblastoma while preserving the continuity of the mandible (without resection). This article presents a series of cases ranging from 18 to 40 years old patients of both sexes with unicystic ameloblastoma, especially in the mandible showing more male predilection than female. All the cases presented in this article were treated by enucleation and curettage. None of the patients presented post?operative paresthesia. None of the cases went in for resection. Post?operative recovery was uneventful in all the patients. All the patients were followed up for a period of 3.5–5 years. None of the cases reported recurrence at the date of publication.
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El ameloblastoma es un tumor odontogénico agresivo que se clasifica en uniquístico, extraóseo/periférico y metastatizante. Una mujer de 42 años acudió al Servicio de Cirugía Oral y Maxilofacial por aumento de volumen hemifacial izquierdo de 6 meses de evolución. Al examen se observó aumento de volumen de la región parotídea y submandibular izquierda, abombamiento tablas óseas mandibulares y movilidad dental. La tomografía axial computarizada reveló una lesión de aspecto quístico en la región mandibular. Se realizó la biopsia incisional y el tratamiento quirúrgico conservador. El diagnóstico histopatológico fue ameloblastoma uniquístico patrón mural. Luego de seis meses de descompresión, se realizó una nueva biopsia incisional, curetaje óseo y se aplicó solución de Carnoy. Once meses posteriores a la primera intervención, se constató radiográficamente aposición ósea de la lesión. El tratamiento de estos ameloblastomas continúa siendo controversial por lo que cada caso se debe abordar de manera única.
Ameloblastoma is an aggressive odontogenic tumor classified as unicystic, extraosseous / peripheral, and metastasizing. A 42-year-old woman was attended at the Oral and Maxillofacial Surgery Service due to a 6-month facial asymmetry. Clinically, we observed a volume increase of the left parotid and submandibular region, bulging of the mandibular bone tables and dental mobility. Computed Tomography revealed a cystic-like lesion in the mandibular region. An incisional biopsy and conservative surgical treatment were performed. The histopathological diagnosis was unicystic ameloblastoma, mural pattern. After six months of decompression, a new incisional biopsy and bone curettage were performed, and Carnoy's solution was applied. Eleven months after the first intervention, bone apposition was observed in the x-ray. The treatment of these ameloblastomas continues to be controversial, so every case should be approached in a unique manner.
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Introduction: Oncogenes and tumor suppressor genes play a major role in cancer formation, growth, and progression. One of the important findings in this area is that murine double minute 2 (MDM2) oncogene is a negative regulator of wild-type p53. In tumors, expressing wild-type p53, inhibition of MDM2 expression will stabilize p53 and allow it to perform its proapoptotic function, while simultaneously preventing MDM2 from exerting its p53-independent oncogenic effects. The intracellular levels of p53 are tightly regulated by MDM2, as it is a key player in autoregulatory feedback loop under nonstressed conditions. The p53-MDM2 relationship is vital not only for essential functions of the cell, but it also appears to be an integrated part of the complex cellular network which supports the importance of this affair and is a hallmark for its coexistence. Subjects and Methods: This study was designed to identify immunohistochemically the expression of p53 and MDM2 gene using monoclonal antibody in 60 cases of formalin-fixed paraffin-embedded tissue blocks, of which 20 cases were of solid multicystic ameloblastoma (SMA), 20 cases were of odontogenic keratocyst (OKC), and 20 cases were of unicystic ameloblastoma (UA). Results: Immunoexpression of p53 and MDM2 was highest in OKC followed by SMA and was minimum in UA. Further results showed positive correlation between both the molecules. Conclusion: The studied showed that the relationship has a significant role in cancer etiology and progression and therefore is an important topic for future research which should help in the development of new therapeutic agent against cancer
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Introdução: O ameloblastoma é uma neoplasia benigna, localmente invasiva, originada do epitélio odontogênico que ainda não possui sua etiologia esclarecida. Este tumor pode ser identificado radiograficamente como unicístico ou multicístico e geralmente, está relacionado com um dente incluso. O tratamento desta patologia do complexo maxilofacial que acomete tanto a maxila quanto a mandíbula, é baseado no diagnóstico clínico, imagens (raios x (RX), tomografia computadorizada (TC) e histopatológico. O objetivo deste trabalho é descrever e avaliar através de tomografia computadorizada (TC), o tamanho do tumor durante o período em que foi submetido à descompressão, para que as dimensões do mesmo possam ser mensuradas e comparadas em intervalos, dessa forma, comprovar a efetividade dos métodos de descompressão e marsupialização quando bem indicados.Relato de caso:No presente relato de caso, o paciente apresenta ameloblastoma unicístico de variante histológica plexiforme, conforme o exame histopatológico e está sendo tratado por meio de descompressão com a finalidade de se obter a diminuição do volume da lesão cística e consequente neoformação óssea, uma vez que a descompressão possibilita este processo. Considerações finais:O tratamento conservador pode surtir efeito tal como nesse caso em que se evidenciou a regressão do tamanho do tumor e a neoformação de estruturas ósseas antes acometidas pela patologia... (AU)
Introduction: Ameloblastoma is a benign neoplasm, locally invasive, originating from the odontogenic epithelium that still does not have a clear etiology. This tumor can be radiographically identified as unicystic or multicystic and is usually related to an included tooth. The treatment of this pathology of the maxillofacial complex that affects both the maxilla and the mandible is based on clinical diagnosis, images (x-rays (X-rays), computed tomography (CT) and histopathology. The objective of this work is to describe and evaluate using computed tomography (CT), the size of the tumor during the period in which it was subjected to decompression, so that its dimensions can be measured and compared at intervals, thus proving the effectiveness of the methods of decompression and marsupialization when well indicated. Case report: In the present case report, the patient has unicystic ameloblastoma of a plexiform histological variant, according to the histopathological examination and is being treated by means of decompression in order to obtain a decrease in the volume of the cystic lesion and consequent bone neoformation, once that decompression makes this process possible. Final considerations: The conserved treatment or it can have an effect as in this case, in which the regression of the tumor size and the new formation of bone structures that were previously affected by the pathology were evidenced... (AU)
Subject(s)
Humans , Female , Child , Ameloblastoma , Ameloblastoma/surgery , Clinical Diagnosis , Decompression , Conservative Treatment , Neoplasms , Wounds and Injuries , Mandible , MaxillaABSTRACT
Ameloblastoma is a benign neoplasm originating from odontogenic epithelium. It is the most common neoplasm in the jaws and is characterized by aggressive behavior and local invasion. Unicystic ameloblastoma (UA) has a unilocular feature in radiologic examination and a cystic feature histologically. Decompression and marsupialization are conservative method of treatment of large UA. The purpose of decompression and marsupialization are size reduction of the mass, which makes it easy to handle at total enucleation with protection of nerve damage and facial deformity. Here we report successful conservative treatment of extensive UA using decompression and marsupialization with a review of literatures.
Subject(s)
Ameloblastoma , Congenital Abnormalities , Decompression , Epithelium , Jaw , MethodsABSTRACT
Ameloblastomas are jaw tumors that are locally aggressive with a high capacity for recurrence. It arises from the epithelium of the dental lamina. Radiograph remains the first and an essential investigation, despite the development of various cross-sectional imaging modalities. Aim: This article intends to describe the clinical findings and orthopantomograph (OPG) supported by computed tomography scan (CT scan) and MRI of four cases of ameloblastomas in the hospital University Sains Malaysia. Materials and methods: Data concerning the patients' ages, sex, tumor locations, and surgical treatment history, as well as the radiographic findings, were analysed. Results: The patients' ages ranged from 23 to 41 years (mean, 30.5 years). The gender of patients were two male (50%) and 2 (50%) females. Three cases (75%) of ameloblastomas located in the mandible and only one case found in the maxilla. The swelling was the most common symptom and experienced by all patients. Radiographically, two cases were unilocular with a well-demarcated border, and the remaining 2 cases were multilocular. Typical features of unicystic ameloblastoma appeared in case 1. This case previously presented with a lesion in the same area diagnosed as a dentigerous cyst. The other 3 cases showed variant types of ameloblastoma. These were Plexiform, Acanthomatous and Granular cell type; follicular and plexiform type; and follicular and plexiform type in case 2, 3 and 4 respectively. Conclusion: In conclusions, determination the location and density of jaws lesion and its margin relation to the tooth using radiological tool accompanied with clinical data, aids in the narrowing of the differential diagnosis and it is necessary for early diagnosis of ameloblastoma. A Long-term follow-up at regular intervals after surgery is recommended for all ameloblastomas cases
Subject(s)
Humans , Male , Female , Ameloblastoma , Mandible , RadiographyABSTRACT
Mandibular shape change caused by the decompression treatment of large unicystic ameloblastoma(UA) involving condylar process was observed in 2 cases and the reasons were analysed.
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Objective@#To evaluate the effect of decompression treated large cystic lesions of the jawsand analyze the influencing factors.@*Methods @#With the panoramic radiographs, the cysts size were measured before and after decompression in 6 dentigerous cysts (DC), 9 keratocystic odontogenic tumors (KTOC) and 10 unicystic ameloblastomas (UA). The reduction rate in the three cystic groups was calculated. Relationships between the age of the patient, the initial size of the cyst and the reduction rate were also analyzed.@*Results@#The reduction size of the three types of cysts at 6 months after decompression: DC group 60.73% ± 7.15%, KTOC group 60.99% ± 4.00%, UA group 59.25% ± 6.81%.There was no difference in their reduction rate between the three types of cysts (P>0.05). However, there was a statistically meaningful relationship between the initial size of the lesion and the absolute reduction rate in the UA and KOTC group (UA group: P<0.01, R=0.99; KTOC group: P<0.01, R=0.86). There was also a significant relationship between the age of the patient and the absolute reduction rate in the DC and UA groups (DC group: P<0.01, R=0.99; UA group: P<0.01, R=0.99). @*Conclusion@#There was no difference in the reduction in size due to decompression between the three types of cysts. However, the age of the patient and the initial size of the lesion showed a significant relationship with the reduction rate.
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BACKGROUND: In this study, we present a case of unicystic ameloblastoma (UA) treated by marsupialization followed by surgical enucleation as a conservative approach. UA is a rare, benign, less aggressive, and less invasive variant of ameloblastoma that is observed quite often in younger patients. Radical approaches have effects on the physical and psychological development of a growing young patient; therefore, conservative approaches are widely used for UA management in children. CASE PRESENTATION: This report described a case of an 11-year-old girl with UA of the mandibular molar–ramus area, which also involved impaction of the second and third molars. The lesion was marsupialized, and 31 months after marsupialization, surgical enucleation was performed with extraction of the impacted third molar. The second molar, which was preserved, spontaneously and completely erupted. No recurrence was observed during a 49-month follow-up. CONCLUSIONS: Conservative treatments for UA in young patients have more advantages. Our results provide evidence that marsupialization is effective in regressing the lesion size to ease complete removal, preserving mandibular growth, maintaining involved second molar, and promoting the eruption of the tooth.
Subject(s)
Child , Female , Humans , Ameloblastoma , Follow-Up Studies , Molar , Molar, Third , Recurrence , Tooth , Tooth EruptionABSTRACT
El ameloblastoma es un tumor odontogénico benigno de origen epitelialcon estroma fi broso maduro sin ectomesénquima odontogénico, decomportamiento localmente agresivo e infi ltrante con alta capacidad de recidiva. Representa entre 11 y 13 por ciento de los tumores odontogénicosmandibulares y 1 por ciento de los tumores y quistes maxilomandibulares. El tratamiento debe orientarse de acuerdo con el potencial del tumor,las características del crecimiento según su variable clínica y el tipo histológico. Debe ser un tratamiento que asegure un mejor pronóstico para el paciente
The ameloblastoma is a benign odontogenic tumor of epithelial origin with mature fi brous stroma, without odontogenic ectomesenchyme. It exhibits locally aggressive and invasive behavior, with a high level of recurrence. Ameloblastomata account for between 11 and 13% of mandibular odontogenic tumors, and 1% of maxillo-mandibular tumors and cysts. Treatment should be guided by the potential of the tumor and its growth characteristics based on the clinical variable and histological type, the preferred treatment being that which ensures the best prognosis for the patient.
Subject(s)
Humans , Male , Middle Aged , Ameloblastoma/surgery , Ameloblastoma/diagnosis , Ameloblastoma/pathology , Odontogenic Cysts/classification , Biopsy/methods , Jaw Fixation Techniques , Maxillofacial Prosthesis , Osteotomy/methods , Prognosis , Oral Surgical Procedures/methods , Radiography, PanoramicABSTRACT
Unicystic ameloblastoma (UA) refers to those cystic lesions that show clinical, radiographic, or gross features of a mandibular cyst, but on histological examination show a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumour growth. UA is believed to be the less aggressive than the solid or multicystic ameloblastomas. We present a case report of 40 year old male patient with UA involving the entire body of the mandible.
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Odontogenic keratocyst (OKC) first described by Philipsen in 1956 constitutes approximately 11% of all cysts of the jaws. Adenomatoid odontogenic tumour (AOT) is an uncommon, benign epithelial lesion of odontogenic origin. The aim of this study was to analyse the expression of Bcl-2 in OKC and its comparison with other selected benign odontogenic tumours (OTs). Ten formalin fixed paraffin embedded blocks of OKCs, five each of AOT and unicystic ameloblastoma Bcl-2 protein is characterized by its ability to inhibit apoptosis. OKC were characterized by higher expression of Bcl-2 in basal cell epithelium. AOT and unicystic ameloblastoma differed from OKC in a wide spectrum of apoptosis and/or cell cycle-related protein expressions, higher proliferation in the basal cell layer, and vice versa, lower proliferation in the suprabasal cell layer. The solitary OKC seems to be less biologically aggressive and should be classified as a cyst rather than a tumour, means that at least few of OKCs manifests as ordinary cysts. Some of the present study findings could support the theory that OKCs are with high proliferative, probably that these lesions are developmental cysts with some neoplastic properties because of the high intrinsic growth potential. WHO recommends the term KCOT as it better reflects the neoplastic nature of the lesion; however, this reclassification has not yet been universally accepted.
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OBJECTIVES: The aim of this study was to verify the clinical effectiveness of decompression in decreasing the size of a cyst. In addition to the different types of cysts, we tried to reveal what effect host factors, such as the initial size of the lesion and the age of the patient, have on the velocity of cyst shrinkage. MATERIALS AND METHODS: With the aid of a panoramic view, we measured the size of the cysts before and after decompression in 13 dentigerous cysts (DCs), 14 keratocystic odontogenic tumors (KTOCs), and 5 unicystic ameloblastoma (UA) cases. The velocity of shrinkage in the three cystic groups was calculated. Relationships between the age of the patient, the initial size of the cyst, and the shrinkage velocity were investigated. RESULTS: The three types of cysts showed no inter-type differences in their velocity of shrinkage. However, there was a statistically meaningful relationship between the initial size of the lesion and the absolute velocity of shrinkage in the DC group (P=0.02, R=0.65) and the KTOC group (P=0.02, R=0.56). There was also a significant relationship between the age of the patient and the absolute velocity of shrinkage in the KTOC group (P=0.04, R=0.45) and the UA group (P=0.04, R=0.46). CONCLUSION: There was no difference in the decrease in size due to decompression among the different types of cysts. However, the age of the patient and the initial size of the lesion showed a significant relationship with the velocity of shrinkage.
Subject(s)
Humans , Ameloblastoma , Decompression , Dentigerous Cyst , Odontogenic Cysts , Odontogenic TumorsABSTRACT
Introduction: During the development of a tooth, the pericoronal tissue may develop pathological changes.The clinical dilemma occurs in the early diagnostic of the tissue around the crown of an uneruptedtooth. Objective: The purpose of this paper is to present a clinical case with different diagnoses of a smallradiolucency area around the crown of impacted teeth on the same patient. The histological diagnosis ofthe follicle related to tooth 48 was of dentigerous cyst and the histological finding of follicular tissue associatedto tooth 38 showed some features of unicystic ameloblastoma. The follicles of teeth 18 and 28 didnot present histopathological changes. Conclusion: The radiographic appearance may not be a reliableindicator of the absence of disease in pericoronal tissues. We recommend histopathological analysis onall surgically extracted follicle tissue, even when radiographic and clinical findings are not indicative ofpathological alterations.
Introdução: Durante o desenvolvimento dental, o tecido pericoronário pode sofrer alterações patológicas.O dilema clínico está no diagnóstico precoce dos tecidos em torno da coroa de um dente retido. Objetivo: O objetivodeste trabalho é apresentar um caso clínico em que houve diferentes diagnósticos histológicos relacionadosaos tecidos pericoronários em um mesmo paciente sem a presença de alteração radiográfica característica.Os diagnósticos histológicos dos folículos dos terceiros molares sugeriram cisto dentígero relacionado ao dente48, características de ameloblastoma unicístico ao dente 38, e os tecidos dos dentes 18 e 28 não apresentaramalterações histopatológicas. Conclusão: O aspecto radiográfico neste caso não foi um indicador confiável daausência de doença em tecidos pericoronários. Logo, recomendamos que todos os tecidos pericoronários sejamencaminhados para o exame histopatológico mesmo que os achados radiológicos e clínicos não mostrem alteraçõespatológicas.
Subject(s)
Humans , Female , Young Adult , Dental Sac/pathology , Tooth, Impacted/pathology , Dental Sac , Radiography, Dental , Tooth, ImpactedABSTRACT
Ameloblastoma is a benign odontogenic neoplasm which frequently affects the mandible. The term ameloblastoma includes several clinico-radiological and histological types. Apart from the most commonly encountered clinico- pathologic models there are few variants, whose biological profile is unknown or not elicited. The reason for lack of understanding is the scarcity of case report published in the literature. Among the types, unicystic ameloblastoma is the least encountered either it presents as unilocular or multilocular radiolucency, but peculiar radiographic presentation of multilocular radiolucency in posterior mandible with unilocular radiographic appearance crossing the midline is extremely rare, which has not been reported yet. Here we report a distinctive case of mural unicystic ameloblastoma of mandible in a 17-year- old- girl with the radiographic presentation as mentioned above.
El ameloblastoma es un tumor odontogénico benigno que frecuentemente afecta a la mandíbula. El término ameloblastoma incluye varias características clínico-radiológicas y tipos histológicos. Aparte de los modelos clínicopatológicos que se encuentran con frecuencia existen algunas variantes, cuyo perfil biológico es desconocido o aún no elucidado. La razón de la falta de comprensión es la escasez de informes de casos publicados en la literatura. Entre los tipos, el ameloblastoma uniquístico es el menos frecuente y puede presentarse como una radiolucidez unilocular o multilocular, pero la peculiar presentación radiográfica de radiolucidez multilocular en el posterior de la mandíbula con aspecto radiográfico unilocular que cruza la línea mediana es extremadamente rara, y aún no se ha reportado. Se presenta un caso de ameloblastoma uniquístico mural de la mandíbula en una paciente de 17 años con la presentación radiográfica anteriormente descrita.
Subject(s)
Female , Ameloblastoma , Mandibular Neoplasms , Ameloblastoma/pathology , Mandibular Neoplasms/pathology , Odontogenic Tumors , Radiography, PanoramicABSTRACT
Unicystic ameloblastoma (UA) is known as a distinct entity which has a less aggressive behavior when compared with conventional ameloblastoma. In this report, we have presented two cases of UAs, (of which one case showed a more aggressive behavior with mural invasion into the adjacent tissues and granular cell differentiation), both of which were successfully managed with enucleation following marsupialization. We aim to highlight how this method can be used for the successful management of such cases, rather than following more aggressive approaches. In both the cases, marsupialization was done for the UA lesions initially and follow-ups were maintained. When the tumor size had regressed on radiographic follow up, an enucleation procedure with ostectomy of the margins was carried out. Special importance was also given to the endodontic treatment of the teeth involved in the area of the lesion. The patients were free of the condition and did not show any signs of recurrence on radiographic follow-ups even after 30 months of the final procedure. Granular variant of UA is quite rare and had been considered to be more aggressive. Marsupialization of UA is an alternative treatment option of resection even for more aggressive variants, as long as the histological behavior of the lesion was carefully evaluated and strict radiographic follow-up is maintained.
Subject(s)
Adolescent , Ameloblastoma/surgery , Apicoectomy/methods , Biopsy , Bone Transplantation/methods , Decompression, Surgical/methods , Female , Follow-Up Studies , Humans , Male , Mandibular Neoplasms/surgery , Middle Aged , Osteotomy/methods , Root Canal Therapy/methods , Tooth, Impacted/surgeryABSTRACT
Unicystic ameloblastoma (UA) refers to those cystic lesions that show clinical, radiographic, or gross features of a mandibular cyst, but on histological examination show a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumour growth. In this case report we present a uncommon multilocular unicystic ameloblastoma encountered in a 40 year old female patient.
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Subject(s)
Ameloblastoma , Curettage , Enamel Organ , Facial Asymmetry , Mandible , Molar , Molar, Third , Odontogenic Cysts , Phenobarbital , Recurrence , Tooth , Tooth, ImpactedABSTRACT
Ameloblastoma is a common odontogenic tumor originating from the dental lamina, reduced dental epithelium and rests of Malassez, and represents 10% of all odontogenic tumors of the jaw. Unicystic ameloblastoma is normally encountered in young patients, and often occurs in the mandible, and is particularly associated with an impacted tooth. We encountered an unicystic ameloblastoma arising from a dentigerous cyst after the treatment of a radiolucent lesion on the mandible.
Subject(s)
Humans , Ameloblastoma , Dentigerous Cyst , Epithelium , Mandible , Odontogenic TumorsABSTRACT
An Ameloblastoma is one of the most common odontogenic tumors. The treatment of ameloblastoma has been controversial because of this disease entity as a slow-growing, locally invasive tumor with high rate of recurrence. Recurrence rate of ameloblastoma are reported 15% to 25% after radical treatment and 75% to 90% after conservative treatment. On the other hand, Robinson and Gardner reported that the recurrence rate after conservative treatment of unicystic ameloblastoma was lower than those of multicystic or solid lesion. In this report, what we want to show is to review the articles to find out pros and cons of conservative treatment of ameloblastoma. In addition we would like to discuss which requies conservative treatment or radical treatment are more acceptable through our case report.