3D cone beam computed tomography reconstruction images in diagnosis of ameloblastomas of lower jaw: A case report and mini review

Cone beam computed tomography (CBCT) has obvious advantages over regular radiography in diagnosis of complex diseases. Objective of this study is to report a case of a mandibular jaw ameloblastoma recurring cyst, which represents a benign tumor of odontogenic epithelium, using CBCT imaging technology. CBCT examination of the patient suffering with recurrent lower jaw cyst (relapsing four years after surgery) showed a decrease in irregular bone density and appearance of a honeycomb pattern (3.5 cm×2.5 cm×1.8 cm) in the right lower jaw. This suggests that the lesion is more likely to be an ameloblastoma. Preoperative tissue biopsy and pathological examination of surgical sample confirmed the diagnosis. Surgical resection of the diseased tissue and autogenous bone grafting in the mandible was performed. Postoperative CBCT examination showed that the bone defect healed well, without recurrence of the tumor 22 months postoperatively. In conclusion, the rotated 3D CBCT images clearly displays the exact size, location, borders and internal changes of the tumor in the jaw cyst itself and the adjacent tissues. Thus, the dental CBCT allows clinicians to better evaluate lesions, leading to better treatment outcomes.

[Unicystic ameloblastoma presenting in Delleman's syndrome]

Ameloblastoma is an odontogenic tumour that represents 1 % of oral tumours but 10 % of odontogenic tumours. Ameloblastoma is characterized by low and noiseless growth, that explains a lot of advanced forms. The tumour is known as benign with local malignity due to its locally invasive behaviour and its recurrence. The treatment choice remains complicated because of recurring nature and large resection in vital anatomical areas. The therapeutic approach will be based on size, anatomical localisation, histologic variants and anatomical complications. The treatment options should be discussed with the patient because of possible important morphological and functional sequelae.

Primary Ameloblastoma of the Temporal Bone

Ameloblastoma is a locally aggressive tumor derived from odontogenic epithelium. Although benign, its clinical behavior can often exhibit malignant characteristics. It is marked by slow and persistent growth with infiltration of adjacent tissues. Almost 70% occur in the mandible in patients older than 30 years. Recurrence of ameloblastoma from inadequate treatment is frequent. Because of its slow growth, recurrences can present decades after primary surgery. A primary ameloblastoma in an area outside the mandibular, maxillary, and infratemporal fossa regions has not been described in detail to date, with only 1 possible case mentioned in the literature. The authors present a case of primary temporal bone ameloblastoma in a 17-year-old boy. The tumor originated in the left mastoid, infiltrated the lateral semicircular canal, facial nerve, and cochlea, and adhered to the sigmoid sinus and posterior cranial fossa dura. Although invasion of multiple structures in the infratemporal fossa and temporal bone leads to variable disease presentation, this case is unique because the first symptom of disease was sudden and recurring unilateral sensorineural hearing loss. Surgery required transection of the facial nerve. Histopathology confirmed primary temporal bone ameloblastoma. The difficulties in achieving wide surgical margins, diagnostics, and further management are addressed.

What Is Important for Confirming Negative Margins When Resecting Mandibular Ameloblastomas?

PURPOSE

The purpose of this study was to assess the utility of intraoperative radiographs and frozen sections in achieving negative margins and preventing recurrence of mandibular ameloblastomas.

MATERIALS AND METHODS

This was a retrospective cohort study of patients who underwent resection (≥1 cm) of mandibular ameloblastomas from 2005 through 2015. Patients were included if they had at least 1-year follow-up and complete records. Demographic variables included age, gender, and type of resection (segmental vs marginal). Predictor variables were type of margin assessment: 1) frozen section, 2) intraoperative ex vivo specimen radiograph, 3) both, or 4) none. The outcome variables were final margin status and recurrence rate. Accuracy of intraoperative radiographic margins was determined by comparison with histologic margin distance. Descriptive statistics were conducted with the Fisher exact test.

RESULTS

The study sample consisted of 35 patients (47.5 ± 20.4 yr old; 16 men) who underwent 25 segmental and 10 marginal resections. Ten had frozen sections only, 3 had ex vivo specimen radiographs only, 10 had no intraoperative measurements, and 12 had both. There were no positive frozen sections. One patient had a positive posterior bony margin at final pathology despite negative frozen section histology. There was no difference in recurrence rate at latest follow-up among cohorts. The anterior radiographic margin was 11.8 ± 5.9 mm compared with 11.5 ± 7.5 mm by histology (P = .124). The posterior radiographic margin was 12.3 ± 5.3 mm compared with 9.8 ± 6.5 mm histologically (P = .546). Margin distances that were at least 5 mm when measured with specimen radiographs had histologic margin distances of at least 5 mm in 25 of 30 resection margins (83.3%).

CONCLUSION

Resection of ameloblastoma with planned margins of at least 1 cm is sufficient to prevent recurrence of ameloblastoma. Achieving a radiographic margin of at least 5 mm provided a histologic margin of at least 5 mm 83.3% of the time.

Resection of an ameloblastoma in a pediatric patient and immediate reconstruction using a combination of tissue engineering and costochondral rib graft: A case report

BACKGROUND AND OVERVIEW

Ameloblastoma is an odontogenic tumor predominantly occurring in patients who are in their 20s and 30s. Approximately 10% to 15% of ameloblastomas occur in patients younger than 18 years. Although it is a benign tumor, an ameloblastoma can have a devastating effect on children both physically and emotionally. The aim of this case report is to demonstrate how tissue engineering and surgical techniques can minimize morbidity and recovery time after extirpation and immediate reconstruction of a mandibular ameloblastoma.

CASE DESCRIPTION

An 11-year-old girl was referred for surgical evaluation of a lesion found on a routine dental radiograph. Resection of a mandibular unicystic ameloblastoma resulted, including immediate reconstruction using a costochondral rib graft, allogeneic bone, bone marrow aspirate concentrate, and recombinant human morphogenetic protein-2. One year postoperatively, the patient had no evidence of recurrence as well as excellent mandibular bone height and width with good facial form. The patient has returned to her daily life without any disabilities or disfigurement.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Dentists are typically the first health care providers to discover oral pathology in patients. The coordination of care by the dental care providers and the oral and maxillofacial specialist was key to the successful outcome for this patient. With biotechnology and surgical techniques, the dental surgeon can extirpate an ameloblastoma and reconstruct the mandible defect to the ideal shape and size with minimal morbidity and recovery time.

Radiological challenges in distinguishing keratocystic odontogenic tumor from ameloblastoma: an extraordinary occurrence in the same patient

OBJECTIVES

The aims of this study are to describe the radiological appearance of two common odontogenic lesions (keratocystic odontogenic tumor and ameloblastoma) arising in the same patient simultaneously with their radiological differences and histological correlates, and to describe challenges in radiological diagnosis.

DESIGN

Single case report.

SETTING

Tertiary referral center.

PARTICIPANTS

Forty-one year-old African-American male patient.

MAIN OUTCOME MEASURE

Lesion appearance on computed tomography (CT) scan and pathological correlates.

RESULTS

A 41year-old African-American male presented with asymptomatic right maxillary swelling. A CT scan of the maxillofacial skeleton showed and expansile and cystic lesion of the right hemimaxilla with trabecular osseous expansion, and a left cystic lesion in the left hemimaxilla expanding into the pterygopalatine fossa. Biopsy confirmed the suspected diagnoses of right ameloblastoma and left keratocystic odontogenic tumor.

CONCLUSION

Although they are among the most common odontogenic tumors, the presence of concurrent ameloblastoma and KOT is an exceedingly rare occurrence in the same patient. The appearance on CT scan may help in distinguishing ameloblastoma from KOT by looking at bone expansion and high density areas, although the gold standard diagnostic test remains open biopsy.

Le Fort I osteotomy for the removal of a rare unicystic ameloblastoma lesion in the maxillary sinus

The unicystic ameloblastoma (UA) presents the clinical and radiographic characteristics of a maxillary cyst, making early diagnosis difficult. A 30-year-old man had an extensive, asymptomatic lesion in the right maxillary sinus. Radiographic examinations demonstrated a retained tooth in association with a lesion. Histopathologic examination revealed the presence of UA with intraluminal and mural infiltration and a follicular pattern. Le Fort I access was chosen for enucleation of the lesion and curettage of the site, which were followed by cryotherapy. The treatment provided adequate intraoperative visibility, enabled the preservation of the surrounding bone, and eliminated postoperative complications. Follow-up over 5 years demonstrated no recurrence.

Practitioners' challenges in diagnosing oral and maxillofacial tumors

OBJECTIVE

Oral cancer is an increasingly growing health care burden in many parts of the world. Due to the relatively low prevalence of oral cancer, screening will lead to a low yield and a high proportion of false positive results. Clinical examination without histologic diagnosis can lead to misdiagnosis in over 40% of cases, especially when premalignant lesions are involved. However, clinical examination is effective especially in detecting the early stages of oral cancer, particularly in high-risk patients, such as smokers and alcoholics. The purpose of the current paper is to describe several cases of failure to diagnose lesions in the oral cavity during clinical and radiographic examinations, and to discuss how these diagnosis failures may be mitigated.

METHOD AND MATERIALS

A series of three cases of oral tumors ranging from benign to malignant that were not recognized and referred in a timely manner, are presented.

CONCLUSION

The difficulties faced by clinicians in diagnosing oral lesions are elucidated in this case series. The current case series, presenting instances in which pathologies were not detected and/or treated in spite of obvious signs, should serve as a warning for dental professionals. The general practitioner is the "first line of defense" for symptomatic and asymptomatic patients, and therefore the implementation of well-established screening protocols is of paramount importance. In light of the low sensitivity ratio of oral examinations, use of biopsies is mandatory when a lesion is suspected.

Mandibular Reconstruction in Ameloblastoma Using Allogeneic Cord Stem Cells and Alloplastic Graft Material - Case Report

Ameloblastoma is a histologically benign odontogenic tumour and has a tendency of locally aggressive behaviour. This is second most prevalent odontogenic tumour and most common in the molar-ramus-angle region and surgical resection is only treatment option. In this article, we propose an innovative approach to deal with these cases by using alloplastic graft with cord stem cells. Over 2.5 years follow-up, we could demonstrate bone regeneration using this technique with no recurrence. To the best of our knowledge, this is the first report of successful regeneration of part of ramus and body of mandible using allogeneic cord stem cells in cases of Ameloblastoma.

A rare variant of calcifying odontogenic cyst with ameloblastoma presentation

Calcifying odontogenic cyst is a rare entity which was first described by Gorlin, and also accounts for 1% of the jaw cysts according to Shear. Due to its diverse histopathology and variable clinical features, there has been a doubt regarding its nature as a cyst or a neoplasm. In this report we present a case of calcifying odontogenic cyst with mural ameloblastomatous presentation in the left body of the mandible in a 19-year-old male patient. This is the 15th case of ameloblastomatous COC being documented in literature.

Recurrent mandibular ameloblastoma with anterior skull base invasion: Case report

Recurrent ameloblastoma with skull base invasion is a rare clinical entity with poor prognosis. We report a case of a mandibular ameloblastoma recurrence involving the anterior skull base. The diagnostic and therapeutic processes are presented with emphasis on the radiologic features of ameloblastoma. Another aim of this case report is to underline the importance of close and long-term follow-up after resection. Ameloblastoma recurrences are frequent and mainly occur after incomplete surgical resection. These recurrences may be diagnosed late because of lack of symptoms in the mandibular area.

Treatment of an extensive unicystic ameloblastoma in a 7-year-old child: the best approach?

Ameloblastoma is a benign, slow-growing neoplasm of the jaw that arises from odontogenic epithelium. We present the case of a 7-year-old girl with a unicystic ameloblastoma of the mandible, and describe our approach to treatment.

Ameloblastic carcinoma of mandible: facts and dilemmas

Ameloblastic carcinoma is a rare malignant odontogenic tumor and is considered as the malignant counterpart of ameloblastoma with features of both benign and malignant histology. It may arise de novo or from a long-standing ameloblastoma and is locally aggressive with a propensity for metastasis. With limited documentation, little is known about its pathobiogenesis, with no universal guidelines for management. For clinicians, differentiating ameloblastic carcinoma from ameloblastoma and malignant ameloblastoma in a patient presenting with a suspicious jaw tumor is a challenge due to overlapping clinical features, inconclusive cytology/biopsy reports, different management approaches and inadequate follow-up. Proper knowledge of the disease entity and a high index of suspicion are essential. Here we elaborate the dilemmas in diagnosis and management of ameloblastic carcinoma through presentation of a representative case in a 56-year-old man presenting with a tumor in the mandible.

Prominent response with helical tomotherapy in recurrent ameloblastic carcinoma of maxillary sinus: a case report

INTRODUCTION

Ameloblastoma is a benign but locally aggressive tumor of odontogenic epithelial tissue. Reports of radiotherapy treatment modalities are limited in the literature.

CASE PRESENTATION

A thirty-five year old male presented with complaints of headache radiating to his face for about six months and impaired vision. The patient's Positron Emission Tomography (PET) showed a mass in the left maxillary sinus extending to the nasal cavity and invading the adjacent tissues. An R2 (macroscopic residual tumor) surgical resection performed to debulk the tumor. Due to the recurrence and residual mass, the patient was treated with helical tomotherapy. At 2 months post-radiotherapy, patient's vision returned to normal. PET scan showed a significant reduction in lesion size 12 months post-radiation.

CONCLUSION

In cases of ameloblastic carcinoma with, post-surgical recurrence or patients not suitable for surgical treatment, helical tomotherapy can be an effective treatment option.

[Clinical research of resection of mandibular benign tumors and primary reconstruction with autogenous bone graft via an intraoral approach]

OBJECTIVE

To investigate the clinical outcomes of resection of mandibular benign tumors and primary reconstruction with autogenous bone graft via an intraoral approach.

METHODS

Fifteen patients with mandibular benign tumors were treated between January 2009 and September 2012. There were 7 males and 8 females, aged from 18 to 45 years (mean, 30 years). The pathological diagnosis identified 11 cases of ameloblastoma, 3 cases of odontogenic keratocyst, and 1 case of odontogenic myxoma. According to the Urken's CRBS (Condyle, Ramus, Body, Symphysis) classification criteria based on the location of the mandibular defect, there were 3 cases of body type (B type), 3 cases of ramus type (R type), and 9 cases of body and ramus type (BR type). The surgeries were performed via an intraoral approach, except 1 patient with the lesion at the level of sigmoid notch via an auxiliary preauricular incision. To fix the bone grafts to the dissected mandibular defects, reconstructive titanium plates were used, either indirectly according to the computer aided design/computer aided manufacturing mandibular models before surgery (9 patients) or directly according to the exposed mandibles during surgery (6 patients). The patients received benign mandibular tumor resection and primary autogenous bone graft reconstruction with free iliac bones (11 cases) or vascularized fibular flaps (4 cases). The mandibular inferior alveolar nerves were preserved in 6 cases.

RESULTS

Primary healing of incision was obtained in 14 patients, while secondary healing in 1 patient suffering from bone graft infection. All the patients were followed up 1-4 years (mean, 2.5 years). At last follow-up, no patients showed facial nerve damage; occlusion of remaining teeth was similar to preoperative conditions; the chewing function was satisfactory; mouth opening was 30-35 mm (mean, 33 mm); and swallowing and speaking functions were normal. Only slight extraoral scars caused by the auxiliary incision and the transbuccal appliances were observed, and all the patients were satisfied with the facial appearance. Lower lip numbness was relived in patients with preserved inferior alveolar nerves. There was no tumor recurrence during follow-up period.

CONCLUSION

The intraoral approach is a feasible and proper approach for resection of benign mandibular tumors and primary reconstruction with autogenous bone grafts, with the advantages of inconspicuous facial scars, minimum damage to the facial nerve, and expectable aesthetic appearance.

Reconstruction of the temporomandibular joint after surgical ablation of a multiply recurrent ameloblastoma: a case report

Reconstruction of large mandibular defects, whether involving the temporomandibular joint (TMJ) or not, has historically been achieved with autogenous grafts, such as free costochondral grafts and vascularized bone grafts. Ensuring intact, functioning microcirculation is critical for graft survival in the face of postoperative radiation therapy secondary to malignant tumour ablation. However, in the case of benign tumours, such as ameloblastomas, postoperative radiation therapy is not required, thus increasing the options for reconstruction. Alloplastic components coupled with nonvascularized bone grafts have been used successfully to restore mandibular form, function and esthetics after extensive mandibular resection. In this article, we describe a case of a multiply recurrent ameloblastoma treated by left hemimandibulectomy and immediate reconstruction with a custom-fabricated alloplastic system in combination with an anterior iliac crest bone graft. The result was a high degree of mandibular function and facial cosmesis, minimal donor-site morbidity, and nearly immediate return to function.

Malignant ameloblastoma in an 8-year-old child with metastasis to the lung: case report with a clinicopathologic analysis

Ameloblastomas are rare tumors of odontogenic origin, accounting for 1% of all oral tumors. They are benign, but locally highly aggressive tumors. We report here the unusual case of an 8-year-old patient with multicystic mandibular ameloblastoma, who was submitted to surgery for two relapses in six years and metastasized to the lung two years after initial surgery. The first lesion, diagnosed as follicular ameloblastoma, was treated conservatively with enucleation and curettage. Two years later the tumor relapsed into multicystic granular form. A marginal conservative resection was performed, keeping the basilar contour of the mandible, due to the age of the patient. Three months later, on a routine follow-up examination, a lung metastasis was detected with no signs of tumor in the mandibular bone and the patient was submitted to upper right lobectomy. Three years later a new recurrent tumor was detected in the alveolar process and another marginal resection was performed. Histologically, the tumor showed the follicular growth pattern. After a disease-free period of over five years, the patient was again submitted to surgery for mandibular reconstruction. The mandibular bony defect was filled with iliac bone blocks and four dental implants. He underwent oral rehabilitation with an implant-supported overdenture. With a follow-up period of 22 years since first surgery, the patient is currently free of disease.

Conservative treatment of an aggressive odontogenic tumor: a case report

An ameloblastoma is a polymorphic, benign, locally invasive tumor made up of odontogenic epithelium, clinically characterized by slow, progressive, painless growth. There are reports in the literature on the treatment of ameloblastomas with aggressive mural invasion through resections, in order to minimize recurrence. However, different approaches may be used at the bone level, such as curettage combined with a chemical fixative (Carnoy's solution), cryotherapy, or thermal cauterization. The findings of this case report demonstrate that the use of Carnoy's solution following the enucleation of a unicysticameloblastoma with mural invasion may be a treatment alternative with a low rate of recurrence, as well as a reduced rate of postoperative complications, a reduction in costs, and preservation of both esthetics and function.

Epidermal nevus and ameloblastoma: a rare association

Epidermal nevi are clinical manifestations of a malformation affecting the embryonic ectoderm. They appear as linear verrucous lesions and are more often located in the skin of the trunk or the extremities. Rarely, verrucous lesions affect the oral mucosa. Epidermal nevi can be a component of epidermal nevus syndrome (ENS), which is characterized by malformations involving several organs, such as the central nervous system. ENS is rarely associated with other solid tumors. We present the case of a patient affected by ENS who developed maxillary and mandibular ameloblastomas. Epidermal nevi were located in the left middle and lower third of the face and in the left cervical region, whereas the ameloblastomas arose within the left maxillary mucosa and within the left mandibular ramus. Features of the syndrome are described and the relevant literature is reviewed.