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.

Ameloblastoma e suas características clínicas e radiográficas: relato de caso clínico / Ameloblastoma and its clinical and radiographic characteristics: clinical case report

O ameloblastoma é um tumor odontogênico benigno raro que afeta a região mandibular. Possui um crescimento localizado, também pode ser infiltrativo e persistente, assintomático, com estímulo desencadeador desconhecido. Sua prevalência ocorre com maior frequência em pacientes entre a quarta e quinta década de vida. Além de ser um relato de caso clínico, o presente estudo visa esclarecer as características clínicas, radiográficas, histopatológicas, condutas e opções durante o tratamento e o prognóstico para os diversos tipos de ameloblastomas, sendo realizada a radiografia panorâmica, a tomografia computadorizada e exame histopatológico, obtendo o diagnóstico da variante unicística que possui as características como uma cavidade monocítica bem definida e radiograficamente apresenta radiolucências expansivas uniloculares com margens bem definidas. O tratamento inicial proposto foi a marsupialização, remoção à marsupialização na qual uma janela cirúrgica comunicando com a cavidade bucal, suturada junto à mucosa adjacente, é aberta para o esvaziamento progressivo do conteúdo interno da lesão, acarretando em sua descompressão, consequente diminuição. Após a reavaliação do caso foi observada a necessidade de remover toda a lesão, realizando a ressecção parcial da mandíbula com um melhor prognóstico(AU)

Ameloblastoma is a rare benign odontogenic tumor that affects the mandibular region, has a localized growth, may also be infiltrative and persistent, asymptomatic, with unknown triggering stimulus. Its prevalence occurs more frequently in patients between the fourth and fifth decade of life. In addition to being a clinical case report, the present study aims to clarify the clinical, radiographic, histopathological, behavioral and options characteristics during the treatment and the prognosis for the various types of ameloblastomas. Panoramic radiography, computed tomography and histopathological examination obtaining the diagnosis of the unicystic variant that has the characteristics as a well defined monocytic cav ity and radiographically presents expansive unilocular radiolucencies with well defined margins. The initial proposed treatment was the marsupialization removal to marsupialization in which a surgical window communicates with the oral cavity, sutured adjacent to the adjacent mucosa, is opened for progressive emptying of the internal contents of the lesion, leading to its decompression and consequent decrease. After the reassessment of the case, it was observed the need to remove the entire lesion, performing partial resection of the mandible with a better prognosis(AU)

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)

Adenomatoid Odontogenic Tumor: A Case Report.

Adenomatoid odontogenic tumor (AOT) is a very rare odontogenic tumor with an incidence of 1%. Overall it accounts for 9% of all odontogenic tumors. In most of the cases, AOT is misdiagnosed as an odontogenic cyst. Younger individuals are commonly affected and particularly in females. AOT is seen predominantly in the maxillary anterior region in association with an unerupted tooth. Permanent dentition is affected more than the deciduous dentition. Intraoral periapical radiographs play a major role in the diagnosis compared to orthopantomogram because of its increased contrast but for the better assessment of the extension of larger lesions orthopantomogram is must. AOT resembles benign odontogenic lesions like dentigerous cyst and tumors like ameloblastoma. The lesions are managed conservatively by surgical excision along with the removal of the affected tooth and have an excellent prognosis.With this background, we report an unusual case of AOT involving maxillary anterior region in 15-year-old male patient. The present article reviews the etiology, clinical features, histopathological features, and treatment modalities of AOT.

Intraluminal Plexiform Unicystic Ameloblastoma: A Report of a Rarity in an 8-year-old Boy.

Unicystic ameloblastoma (UA) is a variant of ameloblastoma and this entity is more common in second to third decade of life. It is very rare in children with <2.2% under the age of 10 years. Th is odontogenic tumor is most commonly encountered in the posterior mandible and is associated with an impacted tooth. Th e term plexiform UA refers to a pattern of epithelial proliferation that has been described in cystic lesions of the jaws. Here is a report of a rare case of intraluminal plexiform UA, in the right posterior mandible of an 8-year-old boy presented to our department.

Ameloblastoma desmoplásico: revisão de literatura / Desmoplastic ameloblastoma: review of the literature

O ameloblastoma desmoplásico é uma variante dos ameloblastomas e caracteriza-se por estroma densamente colagenizado e permeado por pequenas ilhas e cordões de epitélio tumoral odontogênico com pouca tendência para formar estruturas císticas. Clinicamente apresenta-se como um aumento volumétrico facial indolor localizado predominantemente na região anterior da mandíbula; possui pequena predileção pelo sexo masculino e baixa incidência entre os tumores odontogênicos. Radiograficamente é descrito como uma lesão radiolúcida de limites pouco nítidos, semelhante a bolhas de sabão e que pode mimetizar lesões fibro-ósseas. Reabsorção radicular e neoformação óssea podem estar presentes. A tomografia computadorizada e a ressonância magnética nuclear são exames de imagem úteis para o planejamento do tratamento, principalmente devido às margens mal definidas da neoplasia. O tratamento é controverso, mas a maioria dos autores corrobora a necessidade de excisão com adequada margem de tecidos não envolvidos devido ao alto índice de recidivas. Assim, esse trabalho teve como propósito revisar a literatura pertinente ressaltando as especificidades dessa lesão rara. De acordo com a literatura consultada pudemos concluir que as particularidades dessa variedade de ameloblastoma devem ser conhecidas e que, apesar da controvérsia, o tratamento mais seguro ainda é a ressecção com margens de aproximademente 1 cm...

The desmoplastic ameloblastoma is a variant of ameloblastomas and is characterized by densely collagenized stroma and permeated by small islands and strands of odontogenic tumor epithelium with little tendency to form cystic structures. Clinically presents as a painless facial volumetric increase localized predominantly in the anterior mandible; there is a little preference for male and low incidence among odontogenic tumors. Is described radiographically as a radiolucent lesion with ill-defined borders, similar to soap bubbles and can mimic fibro-osseous lesions. Root resorption and bone formation may be present. Computed tomography and magnetic resonance are useful exams for treatment planning, especially due to ill-defined margins of the neoplasm. Treatment is controversial, but most authors corroborates the need for excision with adequate margin of uninvolved tissue due to the high rate of recurrence. Thus, this work aimed to review the literature emphasizing the specifics of this rare lesion. According to the literature we concluded that the characteristics of this variety of ameloblastoma should be known and that despite the controversy, the safest treatment still is the resection with margins of approximately 1 cm...

Augmentation of residual alveolar bone height with tissue engineering for dental implant placement.

The challenge of correcting deficient vertical alveolar height for dental implant placement has been there since dental implants came in to regular clinical placement. The ability of various methods to increase the residual alveolar height has met with varying results. The primary reason is that the techniques were not quite successful in maintaining the required residual alveolar height. Use of Bone Morphogentic Protein, especially rhBMP-2 has been met with high degree of success in deficient vertical alveolar height in a mandibular ridge. The demonstration of this using a case has been presented here.

Intercorrências pós operatórias nas reconstruções cirúrgicas após exérese de ameloblastoma: relato de 3 casos clínicos / Complications postoperatives in surgery reconstructions after excision of ameloblastoma: 3 clinical case report

O ameloblastoma é uma neoplasia benigna agressiva de epitélio odontogênico que corresponde a 1% de todos os cistos e tumores da cavidade oral, e 10% dos tumores odontogênicos em mandíbula. São tumores localmente invasivos que possuem , como apresentação clínica, aumento de volume de crescimento lento e indolor dos ossos gnásticos. Há diversas formas de tratmanto para os diferentes tipos de ameloblastoma, sendo contudo, o tratamento cirúrgico radical o mais indicado para muitos dos casos...

Ameloblastoma mandibular: enfoque diagnóstico y terapéutico / Ameloblastoma of the jaws: diagnostic and terapeutic approach

El ameloblastoma se define como un tumor benigno polimórfico localmente invasivo constituido por una proliferación de epitelio odontogénico en un estroma fibroso que se clasifica dentro de los tumores benignos de epitelio odontogénico con estroma fibroso maduro sin ectomesénquima odontogénico. Constituye aproximadamente el 13% de todos los tumores odontogénicos. No presenta predilección por el sexo siendo más prevalente entre la cuarta y quinta década, aunque puede presentarse a cualquier edad, incluso en niños. Estos tumores presentan un patrón de crecimiento lento y de forma silente, sin signos precoces evidentes, afectando fundamentalmente el hueso mandibular en el 80% de los casos. La actitud terapéutica es compleja por su propensión característica a la recidiva, que surge de la posibilidad de dejar lesiones microscópicas periféricas y del eventual origen pluricéntrico que presentan este tipo de lesiones

Ameloblastoma is a polymorphic benign tumor locally invasive. It is constituted by a proliferation of odontogenic epithelium on a fibrous stroma, and it is classified into benign tumors of odontogenic epithelium with mature fibrous stroma and without odontogenic ectomesenchyme. This type of tumor constitutes approximately the 13% of all types of odontogenic tumors. it grows in both women and men between forty and fifty years old without preference, but it can also appear in people of any age (even in children). This kind of tumor affects mandibular bones and has a silent and slow growth without early signs. Ameloblastoma may be recurrent and it has multiple origins, that is why the treatment is complex and it may cause peripheral and microscopic lesions

[Unicystic ameloblastoma: differential diagnosis and treatment planning]

Unicystic ameloblastoma is a tumor of odontogenic origin. It is not a rare neoplasm and most often the lesion is asympthomatic. However, large lesions may cause painless swelling of the jaws. Here we report a case of unicystic ameloblastoma with pain, swelling of the posterior jaws along with teeth mobility. Samples of incisional biopsy of the lesion and also interaoperative frozen section were sent for pathology and for both samples pathology report was solid ameloblastoma. Due to observing a thick fibrotic wall during the operation, the surgeon decided to perform enucleation. Knowing histopathologic variations of odontogenic tumors and also knowledge about differential diagnosis and clinical and radiographic features can lead to appropriate diagnosis and treatment planning

Ameloblastomas - seven years clinical audit

To determine the pattern and presentations of ameloblastoma in patients reporting to Armed Forces Institute of Dentistry [AFID], a descriptive study was undertaken from June 2002 to June 2009. A total number of 34 Ameloblastoma patients who were treated at the institute were analyzed. Their mode of presentation, site involved, various age groups and gender distributions, histological patterns, clinical and radiological features, treatment offered and follow up was recorded. The age range was from 15 to 65 years with mean age of 37.6 years. Out of 34 patients, 24 [70.6%] were males and 10 [29.4%] were females. Majority of tumours, 28 [82.3%] were present in mandible and the most common site was angle of the mandible 13[38.2%]. Clinically most common feature was swelling without pain and was experienced by 19 [55.9%] patients. Radiographically, there were 19 [55.9%] patients with multilocular radiolucency and 11 [32.4%] patients with unicystic appearance while 4 [11.8%] patients had typical honeycomb appearance. The most common histological pattern was follicular, seen in 21 [61.8%] patients. Enucleation with curettage was carried out in most of the cases 11 [32.4%], marginal resection was done in 10 [29.4%] cases, segmental resection was performed in 7 [20.6%] patients and radical resection with reconstruction was done in 6 [17.6%] patients. Ameloblastoma is one of the most common odontogenic tumour mostly occur in lower jaw. It is locally invasive and have high rate of recurrence therefore early diagnosis, complete excision with safe margins followed by reconstruction and long term follow up is required for psychological and emotional well being of the patient

Ameloblastoma: consequências de um caso mal diagnosticado / Ameloblastoma: consequences of a misdiagnosed case

O presente relato descreve um caso de ameloblastoma ocorrido em região de incisivos inferiores, diagnosticado, erroneamente como alteração periapical de origem endodôntica e periodontal. O paciente foi tratado por um período de 4 anos, durante o qual não foi observada a regressão da lesão. Quando o paciente foi encaminhado para a clínica de Estomatologia da Faculdade de Odontologia da Universidade Federal de Minas Gerais, através dos examens clínico, radiográfico e biópsia incisional, a lesão foi diagnosticada como ameloblastoma. O paciente foi submetido à cirurgia de ressecção parcial em bloco da mandíbula. O caso expõe a mutilação extensa ocorrida com conseqüência de um equívoco no diagnóstico inicial.

Management of mandibular basilar fracture as a complication of tumor surgery

Fracture of the mandible basilar bone after a conservative resection of an ameloblastoma is an unusual postoperative complication and poorly cited in literature, since the radical resection is the most common treatment used for this condition. We present a case dealing with this complication, showing a technique for mandibular reconstruction that creates good results in five years of follow-up.

Estudo clínico-patológico de ameloblastomas: análise de casos / Clinicopathologic study of ameloblastomas: analysis of cases

Analisaram-se casos de ameloblastomas diagnosticados na Disciplina de Patologia Oral da UFRN entre 1970 e 2000, objetivando correlacionar o tipo clínico, os padrões histológicos e o tratamento realizado. O tipo multicístico ocorreu em 87,25 por cento dos casos, o unicístico em 8,5 por cento e o periférico em 4,25 por cento. O aspecto radiográfico foi multilocular em 52,5 por cento dos casos e unilocular em 47,5 por cento. Os padrões histológicos predominantes foram o plexoforme (31,71 por cento) o folicular (17,07 por cento) e o desmoplásico (9,75 por cento). Os tumores com padrão plexiforme acometeram pacientes mais jovens e exibiram menor índice de recidiva do que os foliculares quando tratados por técnicas cirúrgicas conservadoras, realizadas em 77,14 por cento dos casos

Ameloblastoma de maxila: relato de um caso clínico tratamento protético / Maxilla ameloblastoma: a case report of a prosthetic clinical treatment

O ameloblastoma é um tumor benigno, cujo tratamento cirúrgico normalmente leva a grandes perdas de estruturas, mas oferece cura clínica. O tratamento pós-cirúrgico é essencialmente protético, e a reabilitaçäo do paciente visa reparar a mutilaçäo cirúrgica, que ocorre no esqueleto fixo da face e nas estruturas adjacentes, permitindo que o paciente tenha suas funçöes, a estética e o fator psicológico restabelecidos

Considerations on a long-term course of a plexiform amelonlastoma with a recurrence in the soft tissue / Consideraciones de la evolución a largo plazo del ameloblastoma plexiforme con recidiva de tejidos blandos

Los ameloblastomas (ICD-DA.213.XI) son tumores unicéntricos, no funcionales, clínicamente persistentes y benignos, intermitentes en su crecimiento. Desde el punto de vista histológico se pueden distinguir los siguientes patrones: espinocelular, acantomatoso, granular, folicular (simple), basocelular y plexiforme. Hasta ahora no es aún posible determinar los factores pronósticos para el comportamiento de los ameloblastomas. Esto no se puede hacer ni por la clínica, radiología o histología. Sólo los métodos biológicos moleculares, inmunohistoquímicos pueden enfrentar el problema como se muestra durante curso de un ameloblastoma plexiforme (ICD-0-9310.0) muy bien documentado durante 20 años con especial atención a su recidiva en tejidos blandos de mejilla izquierda. Se discuten puntos importantes de la patología y terapéutica. Se requiere de amplia cooperación de las secciones de clínica y patología durante un largo lapso de tiempo en cada caso individual

Ameloblastoma unicístico: apresentação de um caso e revisão da literatura / Unicystic ameloblastoma: case report and literature review

Com a apresentação de um caso de ameloblastoma unicístico em um paciente de 11 anos de idade, foi feita uma revisão de literatura desta lesão e discutida sua etiologia, aspectos clínicos, aspectos radiográficos e tratamento

Ameloblastoma unicistico: consideracoes histopatologicas e tratamento / Unicystic ameloblastoma: histopathologic considerations and treatment

Os autores realizaram uma revisao bibliografica na tentativa de definir a origem e o padrao histopalotogico do ameloblastoma unicistico. O prognostico e as diversas modalidades de tratamento para esta lesao tambem foram discutidos.