Ameloblastoma uniquístico con patrón plexiforme: revisión de la literatura a propósito de un caso clínico / Unicystic ameloblastoma with a plexiform pattern: literature review regarding a clinical case

En 1827 el médico James William Cusack describió una lesión tumoral expansiva con características clínicas similares al ameloblastoma. Para el 2017 la Organización Mundial de la Salud lo clasificó como un tumor odontogénico benigno de origen epitelial. En la actualidad hemos aceptado la teoría de su etiología asociada con una mutación en el biomarcador BRAF-V600E, donde se presentan claras heterogeneidades extra/intratumorales en el metabolismo de la tumorogénesis; la mutación en BRAF genera cambios en la regulación de la odontogénesis, en conjunto con el gen CDC73 presente en el cromosoma 1 q25-q32, lo que produce un cambio en la proteína parafibromina que inhibe la proliferación celular durante el crecimiento y la división celular, esto afecta en conjunto al gen p53 y su homólogo p63 presentes en el cromosoma 17, por lo que se tiene como resultado la expresión de quistes y tumores dentales como el ameloblastoma. La presente obra muestra el caso clínico de un paciente femenino de 11 años de edad con aumento de volumen en la región submandibular izquierda de 7 × 4 cm, con seis años de evolución; de tal manera que fue diagnosticado con ameloblastoma uniquístico y tratado de forma conservadora mediante enucleación, posteriormente fue valorada anualmente hasta que la paciente cumplió los 18 años de edad (AU)

In 1827, physician James William Cusack described an expansive tumor lesion with clinical characteristics similar to ameloblastoma. For 2017, the World Health Organization classified it as a benign odontogenic tumor of epithelial origin. Currently, we have accepted the theory of its etiology associated with a mutation in the BRAF-V600E biomarker, where there are clear extra/intratumoral heterogeneities in the metabolism of tumorigenesis; the BRAF mutation generates changes in the regulation of odontogenesis, together with the CDC73 gene present on chromosome 1 q25-q32, producing a change in the parafibromin protein that inhibits cell proliferation during cell growth and division, which together it affects the p53 gene and its p63 homolog is present on chromosome 17, resulting in the expression of dental cysts and tumors such as ameloblastoma. This work provides the clinical case of an 11-year-old patient with an increase in volume in the left submandibular region of 7 × 4 cm of 6 years of evolution. Being diagnosed as a unicistic ameloblastoma and treated conservatively by enucleation, it is subsequently evaluated annually until the patient reaches 18 years of age (AU)

Hemimandibulectomía por ameloblastoma multiquístico. A propósito de un caso / Multicystic ameloblastoma hemimandibulectomy. A propos of a case

RESUMEN El ameloblastoma es un tumor odontogénico benigno, localmente agresivo y recidivante, con predilección por la región posterior de la mandíbula. Se caracteriza por su agresividad local con muy baja tendencia a metastizarse. El objetivo fue reportar el caso clínico de un paciente con ameloblastoma multiquístico derecho, tratado a través de hemimandibulectomía. Se presentó un paciente masculino, de 44 años de edad, que refirió aumento de volumen del lado derecho de la mandíbula desde hacía aproximadamente un año, acompañado también de otros síntomas, atendido en el Servicio de Cirugía Maxilofacial del Hospital Militar Principal/Instituto Superior, en Luanda, Angola. Los estudios imagenológicos incluyeron radiografía panorámica y tomografía axial computarizada. El diagnóstico clínico patológico fue de ameloblastoma multiquístico. Este tipo de tumor requiere de un adecuado diagnóstico sobre la base de la presentación clínica, localización, tamaño, edad y tipo histológico; de ahí la importancia de conocer las características clínicas e imagenológicas, pues el tratamiento conlleva gran dificultad (AU).

ABSTRACT Ameloblastoma is a benign odontogenic tumor, locally aggressive and recidivist with predilection for back of the jaw, characterized by local aggressiveness and low tendency to metastasize. The aim was reporting the clinical case of a patient with right multicystic ameloblastoma treated through hemimandibulectomy. We presented a male patient aged 44 years, who referred a volume increase of the jaw right side for around a year, accompanied also by other symptoms; he attended the Maxillofacial Surgery Service of the Main Military Hospital/High Institute of Luanda, in Angola. The image studies included panoramic radiography and computerized axial tomography the clinical pathological diagnosis was multicystic ameloblastoma. This kind of tumor requires an adequate diagnosis based on the clinical presentation, location, size, age and histological kind, therefore the importance of knowing the clinical and image characteristics, because the treatment is very difficult (AU).

Assessment of the quality of life of mandibular ameloblastoma patients after reconstruction with double-barrel fibula flap / 中华耳鼻咽喉头颈外科杂志

Objective: To analyse the quality of life of patients receiving repair of bone defect with folded fibula flap after removal of mandibular ameloblastoma. Methods: The case data of 39 patients with ameloblastoma admitted to the First Affiliated Hospital of Zhengzhou University from August 2013 to April 2016 were retrospectively analysed, including 21 males and 18 females, from 18 to 58 years old. 3D printing and digital technology were used in flap preparation before surgery in all patients. The folded fibular flaps were used to repair mandibular defects and the implants were placed between 6-9 months after surgery. The short form-36 health survey questionnaire (SF-36) and the university of Washington quality of life questionnaire (UW-QOL) were applied to evaluate the quality of life of patients before surgery and at 6 months and 24 months after surgery. The higher the score, the better the condition. SPSS 20.0 was adopted for statistical analysis. Results: The SF-36 survey showed that the mean score of body role before surgery (72.4±11.7) was significantly higher than that at 6 months after surgery (39.6±11.1, t=23.580, P<0.05) or that at 24 months after surgery (59.8±6.4, t=8.358, P<0.001). Compared with the preoperative mean scores of Physical Pain (73.0±11.0), General Health (73.4±10.4) and Health Changes (79.2±3.9) before surgery, the mean scores Physical Pain (53.1±7.7), General Health (53.5±7.5) and Health Changes (63.9±11.7) at 6 months after surgery were decreased significantly respectively (t=13.068, 13.756 and 10.880, respectively, all P<0.05), but the mean scores Physical Pain (78.8±14.0), General Health (80.9±12.6) and Health Changes (84.4±4.6) at 24 months after surgery were increased significantly respectively (t=-2.904, -4.027 and -7.586, respectively, all P<0.05), with significant differences in the mean scores of Physical Pain, General Health and Health Changes between 6 and 24 months after surgery (t=-14.241, -16.490, -14.294, respectively, all P<0.001). The UW-QOL survey showed that the mean scores of chewing, language and taste functions decreased at 6 months after surgery (53.1±6.7, 53.0±7.7 and 62.2±9.9, respectively), but improved at 24 months after surgery (67.9±3.9, 63.9±2.9 and 68.4±11.1, respectively), with statistically significant difference (t=-16.765, -11.675 and 2.498, respectively, all P<0.001). Conclusion: The application of folded fibula flaps to repair bone defects after sugery of mandibular ameloblastoma can better meet the needs of language and chewing functions and improve the quality of life of patients.

Tratamento conservador de ameloblastomaunicístico variante plexiforme: relato de caso / Conservative treatment of unicystic ameloblastoma, plexiforme variation: case report

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)

Ameloblastoma: caso clínico patológico en pediatría / Ameloblastoma: a pathological clinical case in pediatrics

El ameloblastoma es un tumor benigno derivado del epitelio odontogénico, clasificado actualmente de acuerdo al CIE 10-EO/SNOMED en el capítulo de tumores (neoplasia) benigna como D16.5/M-93100. Presenta un patrón de crecimiento lento, localmente agresivo, pudiendo causar, o no, grandes deformaciones faciales, en mandíbula o maxilar superior. De localización preferencial mandibular, el 75%, en el área molar y rama ascendente; mientras que, en maxilar superior, se concentran en el área molar con posible compromiso de seno maxilar y suelo de fosas nasales. La edad de presentación más frecuente es entre 20-40 años, siendo rara en pacientes pediátricos. En el tratamiento del mismo se valora tipo clínico, localización y tamaño del tumor, y la edad del paciente. El presente caso clínico destaca la importancia del oportuno diagnóstico clínico-patológico, su clasificación y el uso de nuevas técnicas complementarias (AU)

Ameloblastoma is a benign tumor derived from the Odontogenic epithelium, currently classified according to ICD 10-EO / SNOMED in the Chapter of Benign Tumors (Neoplasia) as D16.5 / M-93100. It has a slow growth pattern, locally aggressive, may or may not cause large facial deformations, in the jaw or upper jaw. Preferential mandibular location, 75% in the molar area and ascending limb; while in the upper jaw they are concentrated in the molar area with possible involvement of the maxillary sinus and the floor of the nostrils. The most frequent age of presentation is between 20-40 years, being rare in pediatric patients. In the treatment of the same, clinical type, location and size of the tumor, as the age of the patient, is assessed. The present clinical case highlights the importance of the appropriate clinical-pathological diagnosis, its classification and the use of new complementary techniques (AU)

Ameloblastoma unicístico: relato de caso / Unicystic ameloblastoma: case report

Objetivo: relatar um caso de ameloblastoma unicístico, com intuito de descrever os seus aspectos clínicos, radiográficos e histopatológicos e a abordagem terapêutica, bem como discutir com base na literatura. Relato de caso: paciente do sexo feminino, 14 anos, procurou a clínica-escola do Curso de Odontologia da Universidade Estadual de Feira de Santana, acompanhada de sua genitora, referindo como queixa principal: "meu queixo tá inchado". No exame físico intrabucal, observou-se tumefação em região mandibular esquerda, circunscrita estendendo-se do dente 31 ao 35, com consistência endurecida a palpação e ausência do dente 33. Foi realizada uma descompressão cirúrgica e biópsia incisional. O diagnóstico histopatológico confirmou a presença de infiltração mural por epitélio ameloblástico. Após confirmado o diagnóstico de ameloblastoma unicístico do tipo mural, o tratamento de escolha foi enucleação e curetagem da lesão. Considerações finais: esse tumor, quando tratado de forma conservadora, apresenta prognóstico favorável. Técnicas alternativas cada vez mais conservadoras estão sendo utilizadas no seu tratamento. Ainda assim, é importante o acompanhamento clínico e radiográfico de longo prazo, devido ao risco de recorrência após longos períodos. (AU)

Objective: this study aimed to report a case of unicystic ameloblastoma to describe its clinical, radiographic, histopathological, and therapeutic aspects, as well as to discuss the literature. Case report: a 14-year-old female patient attended the clinic of the School of Dentistry of Feira de Santana State University, accompanied by her mother, with the main complaint of a swollen chin. The intraoral physical examination revealed tumefaction in the left mandibular region, circumscribed, extending from tooth 31 to 35, hard on palpation, and absence of tooth 33. A surgical decompression and incisional biopsy were performed, and the histopathological diagnosis confirmed the presence of mural infiltration by ameloblastic epithelium. After confirming the diagnosis of mural unicystic ameloblastoma, the treatment of choice was enucleation and curettage of the lesion. Final considerations: this tumor, when treated conservatively, presents a favorable prognosis. Increasingly conservative techniques are being used as alternative treatments of this condition. Nevertheless, long-term clinical and radiographic monitoring is important because of the risk of recurrence after long periods. (AU)

Extenso ameloblastoma unicístico em mandíbula: relato de caso / Extensive unicystic ameloblastoma in the mandible: case report

Objetivo: relatar um caso de ameloblastoma unicístico em região anterior de mandíbula, descrevendo os métodos diagnósticos utilizados e o tratamento empregado. Relato de caso: paciente do gênero feminino, com 40 anos de idade, compareceu ao serviço de Cirurgia e Traumatologia Bucomaxilofacial da Faculdade de Odontologia da Universidade Federal da Bahia, com queixas de aumento de volume em região anterior de mandíbula, com evolução de 10 meses. O exame de imagem revelou lesão unilocular extensa que expandia cortical óssea em região de mento. Optou-se pela biópsia excisional da lesão, sob anestesia geral. O exame do espécime obtido confirmou o diagnóstico de ameloblastoma unicístico, para o qual se decidiu pela manutenção da terapêutica inicial. A paciente segue em acompanhamento pela equipe, sem sinais de recidivas. Considerações finais: o manejo do ameloblastoma unicístico, por vezes, demanda a biópsia excisional da lesão, a fim de diferenciá-la dos cistos odontogênicos e de individualizar seu padrão histológico. A abordagem conservadora pode ser adotada, desde que um acompanhamento rigoroso seja procedido. (AU)

Objective: to report a case of unicystic ameloblastoma in the anterior region of the mandible, describing the diagnostic methods used and the treatment applied. Case report: a 40-year-old female patient attended the Oral and Maxillofacial Surgery and Traumatology Service of the School of Dentistry at the Federal University of Bahia, Brazil, complaining of increased volume in the anterior region of the mandible, with a 10-month evolution. Imaging tests revealed extensive unilocular lesion that expanded the cortical bone in the mental region. Excisional biopsy of the lesion was performed under general anesthesia. The examination of the specimen obtained confirmed the diagnosis of unicystic ameloblastoma, for which it was decided to maintain the initial therapy. The patient is still being followed-up by the team, with no signs of relapses. Final considerations: the management of unicystic ameloblastoma sometimes requires excisional biopsy of the lesion to differentiate it from odontogenic cysts and isolate its histological pattern. The conservative approach may be adopted if along with strict monitoring. (AU)

Ameloblastoma multiquístico de crecimiento rápido con reconstrucción parcial / Multicystic ameloblastoma of fast growing with partial reconstruction

Introducción: El ameloblastoma es una neoplasia benigna, que tiende a ser localmente agresiva, con gran tendencia a la recidiva. Es un tumor odontogénico de origen epitelial; el 80 por ciento de los casos se presenta a nivel mandibular, tanto en rama como en ángulo. Suele manifestarse durante la tercera a quinta décadas de la vida. Las características clínicas no son determinantes del comportamiento biológico y tampoco del pronóstico de un ameloblastoma, ni siquiera en muchos de los casos en los que se complementan con radiografías y/o muestras histopatológicas. Objetivo: Informar el manejo quirúrgico del ameloblastoma multiquístico de manera radical a través de una resección amplia y colocación de placa de reconstrucción que funcionó como mantenedor de espacio, debido a su inusual crecimiento rápido. Presentación de l caso: Se describe un caso clínico de un paciente de sexo masculino, quien presenta una lesión tumoral en rama mandibular derecha, con aspecto clínico de un ameloblastoma de tipo folicular, multiquístico, de crecimiento rápido, tratado en el Hospital Universitario del Caribe de Cartagena, Colombia. Se proporcionan datos sobre su aparición clínica como su rápida evolución, los hallazgos histopatológicos y el manejo terapéutico realizado. Conclusiones: Debido a su crecimiento rápido, para este caso en particular, la opción más factible fue llevar a cabo la resección total de la lesión con el objetivo de evitar o disminuir la posibilidad de recidiva, seguido de reconstrucción con placa de osteosíntesis para devolverle la funcionalidad a la articulación temporomandibular y al hueso mandibular, sin dejar a un lado la estética del paciente(AU)

Introduction: Ameloblastoma is a benign neoplasm that tends to be locally aggressive, with a high tendency to relapse. It is an odontogenic tumor of epithelial origin; 80 percent of cases occur at the mandibular level, both in branch and at an angle. It usually manifests during the third to fifth decade of life. The clinical characteristics are not determinants for the biological behavior or the prognosis of an ameloblastoma, even in many of the cases in which they are complemented with radiographs and/or histopathological samples. Objective: To report the surgical management of multicystic ameloblastoma in a radical way through a wide resection and placement of a reconstruction plate that functioned as a space maintainer, due to its unusual rapid growth. Case presentation: A clinical case of a male patient is described, who presents a tumor lesion in the right mandibular branch, with a clinical appearance of a multicystic, fast growing, follicular ameloblastoma, treated at Hospital Universitario del Caribe in Cartagena, Colombia. Data were provided on its clinical appearance, its rapid evolution, the histopathological findings and the therapeutic management performed. Conclusions: Due to its rapid growth, for this particular case, the most feasible option was to carry out the total resection of the lesion in order to avoid or reduce the possibility of relapse, followed by reconstruction with an osteosynthesis plate to restore the functionality of the temporomandibular joint and of the mandibular bone, without leaving aside the aesthetics of the patient(AU)

Rehabilitation using immediate loading in patients with partial resection of the jaw

ABSTRACT: Ameloblastoma is a rare tumor that affects the maxillomandibular region. Surgical resection is often indicated, and oral rehabilitation becomes a challenge. This study aims to report on the mandibular rehabilitation with implant supported prosthesis using immediate loading with subsequent resection. A patient with a confirmed diagnosis of multicystic ameloblastoma in the left jaw underwent a partial resection of the mandible and a reconstruction with a titanium plate. After 2 years of follow-up with clinical examinations and imaging testing and with no signs of recurrence, the patient underwent the technique of immediate load implants, rehabilitating the mandible with an implant supported fixed prosthesis and the maxilla with a conventional complete denture. During the seven years of follow-up with the patient, there was no sign of recurrence of ameloblastoma. The rehabilitation with oral implants under immediate loading demonstrated to be successful, and the cemented cylinder technique used in this study coupled with passivity showed a favorable prognosis for the longevity of implants.

Off-label use of rhBMP-2 as bone regeneration strategies in mandibular ameloblastoma unicystic / Utilização off-label das rhBMP-2 como estratégia de regeneração do tecido ósseo em ameloblastoma mandibular

ABSTRACT Jawbone reconstruction after tumor resection is one of the most challenging clinical tasks for maxillofacial surgeons. Osteogenic, osteoinductive, osteoconductive and non-antigenic properties of autogenous bone place this bone as the gold standard for solving problems of bone availability. However, the need for a second surgical site to harvest the bone graft increases significantly both the cost and the morbidity associated with the reconstructive procedures. Bone grafting gained an important tool with the discovery of bone morphogenetic proteins in 1960. Benefit of obtaining functional and real bone matrix without need of second surgical site seems to be the great advantage of use bone morphogenetic proteins. This study analyzed the use of rhBMP-2 in unicystic ameloblastoma of the mandible, detailing its structure, mechanisms of cell signaling and biological efficacy, in addition to present possible advantages and disadvantages of clinical use of rhBMP-2 as bone regeneration strategy.

RESUMO A reconstrução óssea dos maxilares após ressecções tumorais é uma das tarefas mais difíceis para o cirurgião maxilofacial. As propriedades osteogênicas, osteoindutoras, osteocondutoras e não antigênicas do osso autógeno o colocam como o padrão-ouro para a solução de problemas de disponibilidade óssea. Entretanto a coleta do enxerto ósseo necessita de um segundo sítio cirúrgico, aumentando significativamente o custo e a morbidade associados ao procedimento reconstrutivo. A enxertia óssea ganhou uma excelente ferramenta com a descoberta das proteínas ósseas morfogenéticas na década de 1960. O benefício da obtenção de matriz óssea verdadeira e funcional, sem a necessidade de um segundo sítio cirúrgico, parece ser a grande vantagem do uso das proteínas ósseas morfogenéticas. Neste contexto, o objetivo deste estudo foi analisar a utilização da rhBMP-2 na regeneração óssea de ameloblastoma mandibular unicístico, detalhando sua estrutura, seus mecanismos de sinalização celular e sua eficácia biológica, além de apresentar potenciais vantagens e desvantagens da utilização clínica das rhBMP-2, enquanto estratégia regenerativa.

Ressecção de ameloblastoma por abordagem intra-oral, vantagens e desvantagens através da apresentação de um caso clínico / Ameloblastoma of resection in approach intra-oral, advantages and disadvantages through the presentation of a case

O objetivo desde trabalho é relatar e discutir um caso de um paciente com ameloblastoma multicístico mandibular que compareceu ao ambulatório do Serviço UFBA/ OSID de Cirurgia e Traumatologia BucoMaxiloFacial cuja ressecção e reconstrução foi realizada por via intra-oral em um tempo único, comentando as vantagens e desvantagens dessa opção terapêutica. Paciente foi encaminhada ao centro cirúrgico para ressecção do ameloblastoma sob anestesia geral. Foi realizada a ressecção parcial da mandíbula com 01cm de margem de segurança. O acesso à lesão foi todo realizado por intra-oral. Procedeu-se a ressecção do tumor, o defeito ósseo foi de aproximadamente 5 cm. A placa de reconstrução foi instalada, reestabelecendo a correta relação insterfragmentos e intermaxilares, e na região do defeito foi interposto um enxerto ósseo livre em bloco tricortical removido da crista ilíaca direita para reconstrução imediata. Conclusão: A abordagem intra-oral para tratamento e reconstrução de neoplasias benignas em região mandibular é uma forma segura e confiável, tendo como principais vantagens à ausência de cicatriz, integridade do nervo facial. E como desvantagens a contaminação por conta das secreções bucais, a infecção do enxerto levando a perda de todo o osso além de ser uma abordagem difícil requerindo habilidade do cirurgião,quando comparado com a abordagem extra-oral, sendo uma técnica bem indicada em casos selecionados(AU)

The aim of this work is to report and discuss a case of a patient with ameloblastoma mandibular multicystic who attended the outpatient clinic of UFBA Service / OSID of Oral and Maxillofacial Surgery whose resection and reconstruction was performed by intraorally in a single time, commenting on the advantages and disadvantages of this therapeutic option. The patient was referred to the operating room for resection of ameloblastoma under general anesthesia. partial resection of the mandible with 01cm margin of safety was performed. Access the injury was all done by intraoral. Proceeded to tumor resection, the bone defect was approximately 5 cm. The reconstruction plate was installed, reestablishing the correct insterfragmentos and intermaxillary relationship, and the defect region was brought a free bone graft in tricortical block removed from the right iliac crest for immediate reconstruction. Conclusion: The intraoral approach to treatment and reconstruction of benign neoplasms in mandibular region is a safe and reliable way, the main advantage of the absence of scarring, facial nerve integrity. The disadvantages contamination because of oral secretions, infection of the graft leading to loss of the entire bone and is a difficult approach requerindo surgeon's skill, compared to the extra-oral approach, being a technique indicated in selected cases(AU)

Surgical management of mandibular ameloblastoma and immediate reconstruction with nonvascularized bone graft and hyperbaric oxygen therapy / Tratamiento quirúrgico de ameloblastoma mandibular y la reconstrucción inmediata con injerto oseo libre y terapia con oxígeno hiperbárico

Extensive resection of tumor often results in bone and soft tissue defects that cause functional and esthetic consequences. The reconstructive surgery is extremely important for the rehabilitation of these patients. The purpose of this study is to report on the use of Hyperbaric Oxygen therapy (HBO) in the case of a large ameloblastoma treated with segmental resection and reconstructed immediately with nonvascularized bone graft (NVBGs) from iliac crest. A 41-year-old woman was referred to our department because of paresthesia of the inferior alveolar nerve and history of swelling in the molar and ramus region of the left mandible. Panoramic radiograph depicting well-defined multilocular radiolucency extending from second pre-molar region to the left ramus region. An incisional biopsy confirms the diagnosis of solid ameloblastoma. The treatment of choice was segmental mandibular resection and immediate mandibular reconstruction using NVBGs from iliac crest, followed by removal of internal fixation and placement of dental implants with immediate loading. The patient received preoperative HBO (a 90-min session at 2.2-2.4 atmospheres, five times per week for two weeks, for a total of up to 10 sessions). Postoperative HBO (10 further 90-min sessions) was administered within 2weeks. The patient received rehabilitation with a mandibular implant-supported fixed complete dental prosthesis. The present study showed successful management of mandibular ameloblastoma that associated extensive surgery, immediate reconstruction with NVBGs from iliac crest, hyperbaric oxygen therapy and dental implants. These combined procedures allowed removal of lesion and reestablishment of mandibular contour and function.

La resección extensa de un tumor a menudo da lugar a defectos del hueso y de los tejidos blandos, que causan consecuencias funcionales y estéticas. La cirugía reconstructiva es extremadamente importante para la rehabilitación de estos pacientes. El propósito de este estudio fue informar sobre el uso de la terapia de oxígeno hiperbárico (HBO) en un caso de un ameloblastoma de gran tamaño, tratado con resección segmentaria y reconstruido inmediatamente con injerto óseo no vascularizado (IONV) de la cresta ilíaca. Una mujer de 41 años fue derivada a nuestro servicio por parestesia del nervio alveolar inferior e historia de hinchazón en la región molar y ramina de la mandíbula izquierda. Radiografía panorámica que muestra una radiolucencia multilocular bien definida que se extiende desde la segunda región pre-molar hasta la región de la rama izquierda. Una biopsia incisional confirma el diagnóstico de ameloblastoma sólido. El tratamiento de elección fue la resección mandibular segmentaria y la reconstrucción mandibular inmediata mediante IONV de cresta ilíaca, seguido de la eliminación de la fijación interna y la colocación de implantes dentales con carga inmediata. La paciente recibió OHB preoperatoria (una sesión de 90 minutos a 2.2-2.4 atmósferas, cinco veces por semana durante dos semanas, para un total de hasta 10 sesiones). La OHB postoperatoria (10 sesiones adicionales de 90 minutos) se administró en 2 semanas. La paciente recibió rehabilitación con una prótesis dental fija con implante mandibular. El presente estudio mostró un manejo exitoso del ameloblastoma mandibular asociado a una cirugía extensa, reconstrucción inmediata con IONV de cresta ilíaca, oxigenoterapia hiperbárica e implantes dentales. Estos procedimientos combinados permitieron la extirpación de la lesión y el restablecimiento del contorno y la función mandibular.

Ameloblastoma maxilar superior: presentación de caso clínico / Upper maxillary ameloblastoma: report of a clinical case

El ameloblastoma es una entidad patológica benigna de origen odontogénico, de alta agresividad local, lo que ha sido un punto de controversia en la literatura científica. Se presenta un caso clínico, con ubicación en maxilar superior con diagnóstico de ameloblastoma sólido multiquístico. Se evalúa el caso, su posibilidad de tratamiento, revisando las características clínicas y anatomopatológicas de laentidad, basándose en una búsqueda bibliográfica.

Ameloblastoma is a benign pathological entity of odontogenic origin, very aggressive at a local level, which has become a controversial issuein cientific literature. A clinic case is presented, located in the superior maxilla diagnosed as a solid multicystic ameloblastoma. The case isevaluated, its ways of treatment, the clinical and anatomopathological characteristics of the entity with an intensive bibliographical researc.

Ameloblastoma uniquístico plexiforme: a propósito de un caso / Plexiform unicystic ameloblastoma: a propos of a case

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.

Management of Large Mandibular Ameloblastoma Crossing Midline: Reconstructed by Bilateral Iliac Crest Graft: A Rare Entity.

Ameloblastoma is a true neoplasm of odontogenic epithelial origin. It is the second most common odontogenic neoplasm. It’s incidence approximately 1% of all oral tumors and 18% of all odontogenic tumors. More than 80% of cases of ameloblastoma occur in mandible. The ameloblastoma occurs in three variants solid or multicystic, unicystic, and peripheral. A painless expansion of the jaws is the most common clinical presentation. The correct diagnosis can be easily made with the help of plain X-rays and tissue biopsy. The standard management of ameloblastoma is marginal resection but sometimes a large tumor requires complete resection of affected part. Untreated tumors may lead to tremendous facial disfigurement, a severe malocclusion and pathological fractures of the jaw. Here we present a case of a young man with the chief complaint of facial asymmetry. The orthopantomogram of the patient was showing a multilocular radiolucency with Buccal and lingual cortical expansion. A diagnosis was made on the basis of the biopsy as multicystic ameloblastoma, and resection of the mandible was carried out. The mandibular primary reconstruction was done with avascular bilateral iliac crest bone graft. Long term prognosis showed satisfactory healing and good facial esthetics.

Aneurysmal Bone Cyst of Mandible: A Case Report.

Aneurysmal bone cysts are rare benign lesions of bone tissue, infrequent in the craniofacial skeleton about other structures like long bones or the spine. The rare jaw lesions encountered in the mandible and maxilla. On the other side, it is at the same time very exciting in terms of its differential diagnosis with other types of mandibular or maxillary bone lesions. We present the case of a 45-year-old female patient with an aneurysmatic cyst located at the left angle of the mandible describing the treatment for the same i.e. surgical excision and hemi mandibulectomy with reconstruction. We have focused on the differential diagnosis, mainly with the malignancies, which can be found at this location, along with therapeutic options classically described for these kinds of pathologies. In our patient, the surgical excision and hemi mandibulectomy allowed a complete removal of the lesion and recon plate was placed for rehabilitation.

Ameloblastoma: a clinical and therapeutic analysis on six cases / Ameloblastoma: uma análise clínica e terapêutica de seis casos

Ameloblastomas are odontogenic tumors that are locally invasive and slow-growing. Their etiology is still not well defined, but the forms of treatment have been widely discussed because of the possibility of tumor recurrence and postoperative complications. In this study, six patients who were diagnosed with ameloblastoma in the mandibular region and were treated in the Department of Orthopedics and Traumatology of Hospital das Clínicas, Federal University of Goiás, between 1958 and 1963, were evaluated. The radiological, clinical and therapeutic characteristics were evaluated. There was no predominance regarding gender in the sample studied. The symptoms most often presented by the patients were pain and tumor formation. The radiological characteristics with greatest incidence were multilocular lesions and the treatment used for all the patients was radical surgery. There was no recurrence over the minimum follow-up period of one year and six months...

Os ameloblastomas são tumores odontogênicos, localmente invasivos e de crescimento lento. Sua etiologia ainda não foi bem definida e as formas de tratamento são amplamente discutidas, por causa de possíveis recidivas do tumor e complicações pós-operatórias. Neste trabalho, foram avaliados seis pacientes diagnosticados com ameloblastoma na região mandibular e tratados no Departamento de Ortopedia e Traumatologia do HC-UFG, de 1958 a 1963. Foram avaliadas as características radiológicas, clínicas e terapêuticas. Não houve predomínio em relação ao gênero na amostra estudada. Os sintomas mais apresentados pelos pacientes foram dor e tumoração. As características radiológicas de maior incidência são de uma lesão multilocular e o tratamento usado em todos os pacientes foi o cirúrgico radical. A recidiva foi nula em um tempo mínimo de um ano e sete meses de seguimento...

Follicular Ameloblastoma: A Case Report.

Ameloblastoma is a true neoplasm of odontogenic origin. It is the most common odontogenic neoplasm, and only odontome out numbers it in reported frequency of occurrence. Th is tumor comprises about 1% of tumors and cysts arising in the jaws. It appears most commonly in the third to fi fth decades and with equal frequency between sexes. Ameloblastoma prevalently occurs in the mandibular molar and ramus areas. Th e patients usually present late after the tumor achieved considerable size to cause facial disfi gurement. Here we present a case of follicular ameloblastoma in a 38-year-old female patient who presented with a swelling on the right side of the mandible.

Tumor odontogênico cístico calcificante com proliferação ameloblastomosa em seio maxilar / Calcifying cystic odontogenic tumor with ameloblastoma proliferation in the maxillary sinus

O tumor odontogênico cístico calcificante (TOCC) com proliferação ameloblastomosa é uma variante rara entre os cistos maxilares. Este trabalho objetiva apresentar o relato clínico de um paciente do sexo masculino, 18 anos de idade, que apresentava aumento de volume extra e intraoral do lado esquerdo da maxila, firme à palpação, de característica normocrômica e indolor. A conduta consistiu em realização de tomografia Cone Beam, biópsia incisional, remoção completa da lesão, curetagem e fixação maxilar. O paciente encontra-se em acompanhamento clínico e radiográfico sem recidiva após doze meses. Dessa forma, ressalta-se a importância do diagnóstico precoce, a conduta clínica empregada e o acompanhamento periódico.

Calcifying cystic odontogenic tumors (CCOT) with proliferative ameloblastoma are a rare variant among maxillary cysts. This study aims to present a clinical report of an 18-year-old male patient with extra and intra oral swelling of the left maxilla, firm to touch, with normochromic characteristics and painless. The clinical approach comprised cone-beam tomography, incisional biopsy, complete removal of the lesion, curettage and maxilla fixation. His clinical and radiographic follow-up has revealed no relapse after 12 months. Hence, this study corroborates the importance of early diagnosis, clinical approach and periodical follow-ups.