Treatment For The Large Aggressive Benign Lesions Of The Jaws

Treatment of benign maxillomandibular osteolytic lesions larger than 4 cm: A systematic review

OBJECTIVE

This systematic review aimed to assess the different treatments of benign maxillo-mandibular radiolucent bone lesions over 4 cm to propose a management algorithm.

STUDY DESIGN

A literature search was conducted using MEDLINE/PubMed, Scopus, Google Scholar, Virtual Health Library databases, and gray literature. Randomized or non-randomized clinical trials and case series with 10 or more patients with a minimum follow up of 1 year, published in French or English until August 2023, were included. The risk of bias was assessed for all papers included.

RESULTS

Of 1433 records identified, 22 were included in this review, reporting data from 1364 lesions. Ameloblastoma was the most common lesion (51.22%) and mandible was the most common site (81.21%). Initial conservative treatment was prevalent (71.04%). Recurrence was higher after conservative (13.8%) than after radical treatments (6.5%). Multilocularity, cortical perforation, dental element preservation were linked to a higher recurrence risk.

CONCLUSION

This study has shown importance of understanding specific characteristics and recurrence risk in benign maxillomandibular osteolytic lesions. Multidisciplinary team approval, personalized approach based on lesion type and patient are crucial. The presence of at least one risk factor could lead to therapeutic decision. Despite limitations, the study informed lesion management and provided precise recommendations.

Marsupialisation for the treatment of unicystic ameloblastoma of the mandible: a long-term follow up of 116 cases

Unicystic ameloblastoma is a unique histopathological type of ameloblastoma, and treatment is controversial. Marsupialisation is effective in reducing the size of cystic lesions and their complications. We have retrospectively analysed the clinical, histopathological, and prognostic data of affected patients who were treated by marsupialisation between 2003 and 2013 in three Chinese hospitals. Our aim was to evaluate the effects and prognosis, and the factors associated with outcome. A total of 116 patients with mandibular unicystic ameloblastomas were included, and 74, 26, and 16 patients were histopathologically classified as being luminal, intraluminal, and mural subtypes, respectively. Most responded well to marsupialisation, with an overall recurrence rate of 12%. Resorption of the root (p<0.001), perforation of the cortical bone (p=0.005), and histopathological subtype (p=0.013) were the main factors that predicted the outcome. Perforation of the cortical bone was the only reliable predictor of recurrence (p<0.001). Disease-free survival function curves indicated that patients with the mural subtype were at a higher risk of recurrence than patients with the other two subtypes (p=0.003). Poor outcomes of marsupialisation were treated surgically and, to date, no subsequent recurrences have been reported. Marsupialisation is effective for these patients, with a recurrence rate similar to that of radical treatment. The outcomes can be predicted using characteristics of the lesion such as resorption of the root, perforation of the cortical bone, and histopathological subtypes. However, additional studies are required to corroborate these findings.

Application of ultrasound in aggressive angiomyxoma: Eight case reports and review of literature

Aggressive angiomyxoma (AAM) is a rare tumour that often occurs in soft tissues of the female genital tract. Eight cases of AAM are reported in this article, and the clinical features and ultrasound and magnetic resonance imaging (MRI) results of the eight cases are reviewed and summarized. The main complaints of all the patients were palpable and painless masses in the vulva or scrotum. The lesions were mainly located in the vulva, pelvis, and perineal region, with a large scope of involvement. The sonographic features of AAM were characteristic. On sonography, all of the masses were of irregular shape and showed hypoechogenicity, with a heterogeneous inner echotexture. Intratumoural and peritumoural blood flows were detected by colour Doppler imaging. On real-time ultrasonic imaging, prominent deformation of the lesions was observed by compressing the masses with the probe. Some special imaging features were also revealed, including a laminated or swirled appearance of inner echogenicity, and a finger-like or tongue-like growth pattern. On MRI imaging, the lesions showed intermediate-intensity signals and intermediate to high-intensity signals on TI-weighted and T2-weighted sequences. A rapid and uneven enhancement pattern was demonstrated. After the comparison of sonographic features with MRI and pathological findings, we found the relevance of the ultrasonographic characteristics with MRI and histological features of AAM. Ultrasound can be a valuable imaging method for the preoperative diagnosis, evaluation of scope, and follow-up of AAM.