Ameloblastic fibroma of the maxillary sinus

Pediatric Odontogenic Cysts and Tumors

Pediatric odontogenic cysts and tumors are rare and often associated with developing or impacted teeth. Odontogenic cysts are broadly categorized as inflammatory or developmental while odontogenic tumors are classified histologically as epithelial, mesenchymal, or mixed tumors. This article will discuss the presentation, diagnosis, and treatment of odontogenic cysts and tumors in the pediatric population.

Ameloblastic fibroma: a stage in the development of a hamartomatous odontoma or a true neoplasm? Critical analysis of 162 previously reported cases plus 10 new cases

OBJECTIVE

To analyze neoplastic and hamartomatous variants of ameloblastic fibromas (AFs).

STUDY DESIGN

Analysis of 172 cases (162 previously reported, 10 new).

RESULTS

AF emerged as a lesion primarily of children and adolescents (mean age, 14.9 years), with about 80% diagnosed when odontogenesis is completed (age, < 22 years). Around 28% of all AFs were small and asymptomatic, and 72% exhibited moderate-to-severe bone expansion.

CONCLUSIONS

There are 2 variants of AF: neoplastic and hamartomatous. Lesions in patients aged >22 years are considered true neoplasms, while those in younger patients may be either true neoplasms or odontomas in early stages of development. Although the histopathology of hamartomatous and neoplastic variants of AF are indistinguishable, clinical and radiologic features can be of some help to distinguish between them. Asymptomatic small unilocular lesions with no or minimal bone expansion in young individuals are likely to be developing odontomas, and large, expansile lesions with extensive bone destruction are neoplasms.

Odontogenic tumors of the maxillary sinus

PURPOSE OF REVIEW

To help the clinician understand the different odontogenic tumors found commonly in the maxillary sinus in terms of clinical and radiographic findings, diagnosis and treatment.

RECENT FINDINGS

The classification of odontogenic tumors has changed recently with the addition of the odontogenic keratocyst and calcifying odontogenic cyst (Gorlin cyst) from the realm of odontogenic cysts to being classified by the WHO as odontogenic tumors based upon their neoplastic biologic behavior. The odontogenic keratocyst is now called a keratocystic odontogenic tumor. The calcifying odontogenic cyst is now called a calcifying cystic odontogenic tumor.

SUMMARY

The diagnosis of odontogenic tumors of the maxillary sinus is difficult and challenging. Surgeons need to work in conjunction with an oral and maxillofacial pathologist to ensure accurate diagnosis for proper surgical planning.

Ameloblastic fibroma: A review of published studies with special reference to its nature and biological behavior

To further elucidate confusions with respect to the nature and biological behavior of ameloblastic fibroma (AF), available English-language literature since its first description in 1891 was reviewed. A total number of 123 cases with well-documented follow-up data were retrieved to evaluate various clinical, pathological and behavioral aspects of this tumor. AF tends to occur in the first two decades (89/123; 72.4%), but patients older than 22 years are not uncommon (30 cases). An overall recurrence rate of 33.3% (41 cases) is identified in reported cases who were treated by conservative (91.5%) and radical (8.5%) methods. Malignant transformation is evident in 14 recurrent tumors with an overall transformation rate of 11.4%. These data support the view that majority of AFs are true neoplasms. However, a small number of AFs occurring in childhood may represent the primitive stage of a developing odontoma, as three of the reported recurrent AFs do show further maturation with formation of dental hard tissues. A significantly longer recurrence-free survival was noted in patients treated by radical procedures in comparison to those treated by conservative methods and the age of patients at the first presentation was significantly related to malignant transformation of AF. As we are unable, at present, to differentiate a hamartomatous lesion from a neoplasm among this group of lesions merely on histologic grounds, age of the patients should be an important consideration when choosing therapeutic methods. Radical surgery should not be employed for the treatment of AFs in young people.

[Ameloblastic fibro-odontoma of the maxillary sinus]

INTRODUCTION

Ameloblastic fibro-odontoma, ameloblastic fibroma, and odontoma are rare malformations, which are classified as odontologic tumors. They usually progress in an asymptomatic way, and making the histological distinction between these variants is very difficult.

OBSERVATION

We report the case of a 14-year-old girl presenting with an ameloblastic fibro-odontoma of the maxillary sinus. The clinical signs were nasal obstruction and jugular tumefaction. Surgical excision was performed through a paralateronasal approach. The diagnosis of fibro-odontoma was confirmed by the histopathological analysis of the surgical piece.

DISCUSSION

Odontologic tumors form a complex entity, the histological nature and the correlations of which are discussed.