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Chen C, Batstone M, Taheri T, Johnson N. Surgical Resection and Reconstruction of Ameloblastoma: A 13-Year Retrospective Review. J Oral Maxillofac Surg 2024; 82:862-868. [PMID: 38636548 DOI: 10.1016/j.joms.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Ameloblastoma is a locally aggressive, benign tumor presenting in the maxilla and mandible prone to recurrence. Resection greatly limits recurrence; however, reconstruction becomes critical to preserve patients' functionality and esthetics. PURPOSE The aim of this study was to describe surgical resection and reconstructive approaches in the treatment of ameloblastoma and compare clinical outcomes to conservative methods of treatment. STUDY DESIGN, SETTING, SAMPLE A retrospective case series was completed through analysis of patient records. The study population was composed of patients treated for ameloblastoma at the Royal Brisbane Hospital (Queensland, Australia) in the Oral and Maxillofacial Surgery Unit from January 1, 2008, to December 31, 2020. Patients without histological confirmation of intraosseous ameloblastoma were excluded from the study sample. PREDICTOR VARIABLE Not applicable. MAIN OUTCOME VARIABLE(S) The primary outcome variable was time to recurrence. Secondary outcome variables included any surgical complications incurred. COVARIATES The covariate variables collected included age at diagnosis/treatment, gender, ethnicity, location of lesion and site(s) of involvement, tumor extent, alveolar expansion, histopathological growth pattern, and soft tissue involvement. ANALYSES Descriptive statistics were computed for each study variable. RESULTS A total of 48 cases of histologically confirmed ameloblastoma were identified (41 mandibular, 7 maxillary) involving 50 excisional operations (44 resections, 6 enucleations). Of these cases, 44 were followed up > 12 months, with a mean length of follow-up time of 65.6 months. No recurrence was detected for resected lesions. One enucleated lesion recurred at 25 months. Thirty-seven reconstructive procedures were undertaken, including 32 immediate free flaps. All reconstructive flaps and grafts survived, and no major complications were recorded. CONCLUSION AND RELEVANCE Resection of ameloblastoma limits recurrence and should be considered curative. Immediate microvascular free flap reconstruction of maxillary and mandibular defects from resection of ameloblastoma is safe and predictable.
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Affiliation(s)
- Cheryl Chen
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Unit, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - Martin Batstone
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Unit, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Touraj Taheri
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Anatomical Pathology, Pathology Queensland, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Nigel Johnson
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Alarcón-Sánchez MA, Becerra-Ruíz JS, Yessayan L, Mosaddad SA, Heboyan A. Implant-supported prosthetic rehabilitation after Ameloblastomas treatment: a systematic review. BMC Oral Health 2023; 23:1013. [PMID: 38110933 PMCID: PMC10729555 DOI: 10.1186/s12903-023-03765-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Ameloblastoma (AM), the benign counterpart of ameloblastic carcinoma, is a benign odontogenic tumor of epithelial origin, naturally aggressive, with unlimited growth potential and a high tendency to relapse if not adequately removed. Patients with AM treated surgically can benefit from dental implant therapy, promoting oral rehabilitation and improving their quality of life. The present study aimed to determine the survival rate of dental implants placed after surgical treatment of patients affected by AM. In addition, there were two secondary objectives: 1) To evaluate which dental implant loading protocols are most frequently used and 2) To determine the type of prosthetic restoration most commonly used in these patients. METHODS The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed during the study. Searches were performed in three databases (PubMed/MEDLINE, Scopus, and Google Scholar) until November 2023. Additionally, the electronic search was enriched by an iterative hand search of journals related to oral pathology and medicine, maxillofacial surgery, and oral prosthodontics and implantology. Only reports and case series in English from January 2003 to date were included. The Joanna Briggs Institute tool (JBI-Case Reports/Case Series) was used for the study quality assessment. RESULTS The total number of patients and implants studied were 64 and 271, respectively, all with surgically treated AM. The patient's ages ranged from 8 to 79 years, with a mean (SD) age of 37.3 ± 16.4. Fifty-three percent were male and 47% were female. The range of follow-up duration was 1 to 22 years. An implant survival/success rate of 98.1% was reported. In addition, most of them were conventionally loaded (38.3%). Hybrid implant-supported fixed dentures were the most commonly used by prosthodontists (53%). CONCLUSIONS Oral rehabilitation with dental implants inserted in free flaps for orofacial reconstruction in surgically treated patients with AM can be considered a safe and successful treatment modality.
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Affiliation(s)
- Mario Alberto Alarcón-Sánchez
- Biomedical Science, Faculty of Chemical-Biological Sciences, Autonomous University of Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Julieta Sarai Becerra-Ruíz
- Institute of Research of Bioscience, University Center of Los Altos, University of Guadalajara, Tepatitlán de Morelos, Jalisco, Mexico
| | - Lazar Yessayan
- Department of Therapeutic Stomatology, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Seyed Ali Mosaddad
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Qasr-e-Dasht Street, Shiraz, Iran.
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, 0025, Yerevan, Armenia.
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Subramani V, Govindarajan Valandhan Vedha G, Vijayarani P. Results of the Modified Brosch Approach and Rehabilitation of Mural Unicystic Ameloblastoma of the Mandible in a Young Patient. Cureus 2023; 15:e36441. [PMID: 37090330 PMCID: PMC10116076 DOI: 10.7759/cureus.36441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 04/25/2023] Open
Abstract
Although radical surgery results in craniofacial deformity, functional damage, and aesthetic harm, all of which have an immediate negative impact on a patient's quality of life, it also has the lowest recurrence rate for biologically aggressive subtypes of mural unicystic ameloblastomas. The oral approach removes the lingual cortex and exposes the entire buccal cortical plate in the area of the ascending and horizontal ramus to the full extent of the lesion. There is no obvious distortion of the soft tissues of the face following the modified Brosch procedure, which is also associated with rapid bone regeneration. This approach resulted in less invasive surgery and low surgical morbidity and recurrence in a young adult with a large mural unicystic ameloblastoma.
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Affiliation(s)
- Vijayanirmala Subramani
- Oral Pathology and Microbiology, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Giri Govindarajan Valandhan Vedha
- Oral and Maxillofacial Surgery, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Preethi Vijayarani
- Oral and Maxillofacial Surgery, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Singh CA, Devaraja K, Kumar R. Recurrent Ameloblastoma: Long Term Outcomes with Free Fibular Bone Graft. Indian J Otolaryngol Head Neck Surg 2022; 74:1773-1779. [PMID: 36452534 PMCID: PMC9702040 DOI: 10.1007/s12070-020-01790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022] Open
Abstract
Ameloblastoma is a locally aggressive benign neoplasm of jaw that has high propensity to recur. Pathological subtype and intent of surgical excision during primary surgery are two factors that are known to affect the prognosis in these cases. Nevertheless, there are hardly any studies which have studied recurrent ameloblastoma cases. Apart from sharing a tertiary care cancer center's experience in managing a series of recurrent ameloblastoma cases, we discuss some of the recent literature related to pathophysiology and principles related to their surgical management. Retrospective chart review of all those recurrent ameloblastoma cases which were operated between October 2013 and January 2016 and were subsequently followed up for minimum of 3 years. Total of 9 recurrent ameloblastoma cases were operated in the study period. All our patients had less-radical or non-curative intent surgical treatment in the past, and current treatment consisted wide excision of the involved segment of mandible with free fibular reconstruction. Among the 6 patients who were followed up for more than 3 years, none developed recurrence at 56.5 months of mean follow up duration. Almost all these patients had optimal results with good quality of life in terms of oral speech intellectuality and cosmetic perception of self. Complete excision of the involved segment of bone with reconstruction using the composite free fibular graft can provide optimal functional outcomes and can significantly lessen the chances of further recurrences.
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Affiliation(s)
- Chirom Amit Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - K. Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
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Alloplastic Temporomandibular Joint Reconstruction Following Recurrent Ameloblastoma Resection. J Craniofac Surg 2021; 33:284-288. [PMID: 34510060 DOI: 10.1097/scs.0000000000008124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Ameloblastomas are benign tumors that most commonly affecting the mandible. The current standard of treatment for ameloblastomas is resection followed by reconstruction that has historically been accomplished through the use of a microsurgical vascularized flaps taken from the iliac crest or fibula. Alloplastic reconstruction methods have gained popularity over recent years with success reported in the reconstruction of many pathologies, including ankylosis, condylar fracture, neoplasia involving extensive resection, severe inflammatory/degenerative temporomandibular joint (TMJ) disease, and congenital TMJ abnormalities. The authors present a patient who successfully underwent ameloblastoma resection and TMJ reconstruction with a custom TMJ Concepts alloplastic implant. The authors also present a review of the literature on alloplastic TMJ reconstruction following ameloblastoma resection. To our knowledge, this is the second report in the literature on the use of a TMJ Concepts implant after ameloblastoma resection.
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Slusarenko da Silva Y, Tartaroti NA, Sendyk DI, Deboni MCZ, Naclério-Homem MDG. Is conservative surgery a better choice for the solid/multicystic ameloblastoma than radical surgery regarding recurrence? A systematic review. Oral Maxillofac Surg 2018; 22:349-356. [PMID: 30191338 DOI: 10.1007/s10006-018-0715-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 08/24/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Determine if conservative surgery of primary solid/multicystic ameloblastoma (SMA) is capable of decreasing the recurrence rate as effectively as radical surgery. METHODS We searched in MEDLINE, Web of Science, Scopus and Cochrane Library for original studies reporting on the conservative or radical treatment of primary SMA and the related recurrence rate. All selected data were independently assessed. Meta-analysis was performed and the Relative Risk (RR) of recurrence with a confidence interval of 95% was the effect measure. P value for the summary effect of < 0.05 was considered statistically significant. RESULTS The 2647 records retrieved were reduced to 7 studies to be qualitatively assessed and 4 studies were included in the meta-analysis. RR of 1.88 [0.59, 5.95] of the pooled values pointed that recurrence rate after the conservative surgery is neither comparable nor lower than the radical surgery (P = 0.28). CONCLUSIONS Conservative surgery does not reduce the recurrence rate as efficiently as radical surgery for primary SMA. However, there is not enough evidence to support this statement.
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Affiliation(s)
- Yuri Slusarenko da Silva
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Av Prof. Lineu Prestes 2227 Butantã, São Paulo, 05508-000, Brazil.
| | - Natalia Aguiar Tartaroti
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Av Prof. Lineu Prestes 2227 Butantã, São Paulo, 05508-000, Brazil
| | - Daniel Isaac Sendyk
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Av Prof. Lineu Prestes 2227 Butantã, São Paulo, 05508-000, Brazil
| | - Maria Cristina Zindel Deboni
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Av Prof. Lineu Prestes 2227 Butantã, São Paulo, 05508-000, Brazil
| | - Maria da Graça Naclério-Homem
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Av Prof. Lineu Prestes 2227 Butantã, São Paulo, 05508-000, Brazil
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Petrovic ID, Migliacci J, Ganly I, Patel S, Xu B, Ghossein R, Huryn J, Shah J. Ameloblastomas of the mandible and maxilla. EAR, NOSE & THROAT JOURNAL 2018; 97:E26-E32. [PMID: 30036443 DOI: 10.1177/014556131809700704] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Ameloblastoma is a histologically benign but locally aggressive tumor of the jaws. We conducted a retrospective cohort study to review the clinical, radiologic, and pathologic features of patients with ameloblastoma of the mandible and maxilla and to report the outcomes of treatment. Our study population was made up of a series of 30 consecutively presenting patients-15 men and 15 women, aged 19 to 81 years (median: 61.5)-who had undergone their primary treatment of ameloblastoma of the mandible or maxilla at Memorial Sloan Kettering Cancer Center from January 1987 through December 2012. In addition to demographic data, we compiled information on clinical characteristics, imaging findings, the type of surgery, surgical margins, adjuvant treatments, histologic patterns, length of follow-up, time to recurrence, treatment of recurrence, and factors that had an influence on recurrence. All but 2 patients with negative margins were cured. Favorable outcomes were associated with the administration of adjuvant postoperative radiotherapy for patients with positive margins and a repeat resection for patients with recurrences. Complete excision with negative margins, however, remains the gold standard for curative treatment.
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Affiliation(s)
- Ivana D Petrovic
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA
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Mandibular Condyle Reconstruction With Fibula Free-Tissue Transfer: The Role of the Masseter Muscle. J Craniofac Surg 2018; 28:1955-1959. [PMID: 28938332 DOI: 10.1097/scs.0000000000003998] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Free fibula flap is an option for primary restoration after disarticulation mandibular resection, though literature on technique refinements is scarce. The authors hypothesized that inset of the masseter, the key mandibular elevator muscle, at the reconstructed mandible may optimize functional recovery. METHODS All patients undergoing reconstruction of mandibulectomy-condylectomy defect (January 2009 to January 2014) by means of a fibular flap were prospectively studied. The neocondyle was formed by the distal portion of the fibula and placed directly into the glenoid fossa with preservation of the temporomandibular disc. The deep portion of the masseter was inset at the angle of the reconstructed mandible.Condylar position was postoperatively evaluated by panoramic radiographs. Patients self-evaluated speech, chewing, swallowing, and facial appearance. RESULTS Two patients had immediate and 3 delayed reconstruction involving condyle ramus body, in the study period. During a mean follow-up of 32 months, 4 patients had satisfactory occlusion, 1 patient had an open-bite deformity, but was able to masticate solid food and maintain an oral diet. Although no significant condyle dislocation was recorded, 2 patients had slight ipsilateral deviation on mouth opening. Nevertheless, cosmesis was satisfactory and all patients maintained intelligible speech. Functional score was 13.6 ± 1.14 and facial appearance score was 4 ± 0.7. CONCLUSION The free fibula transfers with direct seating of the fibula into the condylar fossa followed by masseter muscle reinsertion provides acceptable functional reconstruction of the mandibulectomy-condylectomy defect.
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Fahradyan A, Odono L, Hammoudeh JA, Howell LK. Ameloblastic Carcinoma In Situ: Review of Literature and a Case Presentation in a Pediatric Patient. Cleft Palate Craniofac J 2018; 56:94-100. [PMID: 29715060 DOI: 10.1177/1055665618774021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Ameloblastic carcinomas are rare malignant lesions with 3 mandibular pediatric cases reported in the literature. We present a case of ameloblastic carcinoma in situ in a 15-year-old male with a right mandibular cystic lesion on computed tomography. The incisional biopsy revealed plexiform ameloblastoma. Due to the infiltrating and aggressive nature of the tumor, the patient underwent hemimandibulectomy and immediate reconstruction with a vascularized osteocutaneous fibula free flap. The final pathology was read as ameloblastic carcinoma in situ. Given the rarity of this disease in the pediatric population, this case report may be a valuable addition to the current literature.
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Affiliation(s)
- Artur Fahradyan
- 1 Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Lauren Odono
- 2 Division of Oral and Maxillofacial Surgery, Ostrow School of Dentistry of USC, Los Angeles, CA, USA
| | - Jeffrey A Hammoudeh
- 1 Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.,2 Division of Oral and Maxillofacial Surgery, Ostrow School of Dentistry of USC, Los Angeles, CA, USA.,3 Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Lori Kathryn Howell
- 1 Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.,3 Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
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Miceli ALC, Pereira LC, Torres TDS, Calasans-Maia MD, Louro RS. Mandibular Reconstruction with Lateral Tibial Bone Graft: An Excellent Option for Oral and Maxillofacial Surgery. Craniomaxillofac Trauma Reconstr 2016; 10:292-298. [PMID: 29109841 DOI: 10.1055/s-0036-1593475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 07/30/2016] [Indexed: 10/20/2022] Open
Abstract
Autogenous bone grafts are the gold standard for reconstruction of atrophic jaws, pseudoarthroses, alveolar clefts, orthognathic surgery, mandibular discontinuity, and augmentation of sinus maxillary. Bone graft can be harvested from iliac bone, calvarium, tibial bone, rib, and intraoral bone. Proximal tibia is a common donor site with few reported problems compared with other sites. The aim of this study was to evaluate the use of proximal tibia as a donor area for maxillofacial reconstructions, focusing on quantifying the volume of cancellous graft harvested by a lateral approach and to assess the complications of this technique. In a retrospective study, we collected data from 31 patients, 18 women and 13 men (mean age: 36 years, range: 19-64), who were referred to the Department of Oral and Maxillofacial Surgery at the Servidores do Estado Federal Hospital. Patients were treated for sequelae of orthognathic surgery, jaw fracture, nonunion, malunion, pathology, and augmentation of bone volume to oral implant. The technique of choice was lateral access of proximal tibia metaphysis for graft removal from Gerdy tubercle under general anesthesia. The mean volume of bone harvested was 13.0 ± 3.7 mL (ranged: 8-23 mL). Only five patients (16%) had minor complications, which included superficial infection, pain, suture dehiscence, and unwanted scar. However, none of these complications decreases the result and resolved completely. We conclude that proximal tibia metaphysis for harvesting cancellous bone graft provides sufficient volume for procedures in oral and maxillofacial surgery with minimal postoperative morbidity.
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Affiliation(s)
- Ana Lucia Carpi Miceli
- Department of Oral and Maxillofacial Surgery, Servidores do Estado Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Livia Costa Pereira
- Department of Oral and Maxillofacial Surgery, Servidores do Estado Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thiago da Silva Torres
- Department of Oral and Maxillofacial Surgery, Servidores do Estado Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rafael Seabra Louro
- Department of Oral and Maxillofacial Surgery, Servidores do Estado Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil.,Oral Surgery Department, Dentistry School, Fluminense Federal University, Niterói, Rio de Janeiro
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Gravvanis A, Koumoullis HD, Anterriotis D, Tsoutsos D, Katsikeris N. Recurrent giant mandibular ameloblastoma in young adults. Head Neck 2015; 38 Suppl 1:E1947-54. [PMID: 26716398 DOI: 10.1002/hed.24352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 05/17/2015] [Accepted: 10/18/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of the study was to define the most appropriate management of the giant mandibular ameloblastoma (GMA) in young adults. METHODS A retrospective study was performed on patients with GMA <30 years old. The data collected included initial treatment, tumor margins, reconstruction, and follow-up. Patients evaluated speech, chewing, swallowing, and facial appearance after definitive treatment. RESULTS Thirteen patients were identified with recurrent solid/multicystic disease requiring further treatment. Definitive treatment involved segmental mandibulectomy and reconstruction with free fibular flap in all patients. Seven patients had immediate reconstruction (group A) and 6 had secondary (group B). Mandibular resection was planned at least 2 cm beyond the radiological limit, free margins were achieved in all patients, and all flaps were transplanted successfully. In group A, functional score was 13.7 ± 0.45 and facial appearance score was 4.5 ± 0.49, whereas in group B were 11.16 ± 0.37 and 3.3 ± 0.5, respectively (both p < .05). CONCLUSION Aggressive resection of the GMA and immediate reconstruction is strongly advised. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1947-E1954, 2016.
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Affiliation(s)
- Andreas Gravvanis
- Department of Plastic Surgery - Microsurgery and Burn Center " J. Ioannovich", General State Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Harry D Koumoullis
- Department of Oral and Maxillofacial Surgery, General State Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Dimitrios Anterriotis
- Department of Oral and Maxillofacial Surgery, General State Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Dimosthenis Tsoutsos
- Department of Plastic Surgery - Microsurgery and Burn Center " J. Ioannovich", General State Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Nick Katsikeris
- Department of Oral and Maxillofacial Surgery, General State Hospital of Athens "G. Gennimatas", Athens, Greece
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12
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Rehabilitation with dental implants in microvascular iliac graft after solid ameloblastoma resection: a case report. IMPLANT DENT 2015; 22:561-5. [PMID: 24168903 DOI: 10.1097/id.0000000000000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Ameloblastoma is a true odontogenic tumor that is most frequently found in clinical practice. Osseous resection with clear margins is the recommended treatment followed by bone reconstruction, such as a vascularized graft. The use of osseointegrated dental implants for rehabilitation is advisable, as it allows the recovery of the masticatory function. MATERIALS AND METHODS This case report includes 1 subject, a patient who presented with a large ameloblastoma treated by resection, a microvascular iliac graft, and dental implants. RESULTS After 6 months of regular control, the patient exhibited perfect healing of both the soft tissues and bone graft. At the time of this report, the patient had undergone 36 months of clinical and radiographic follow-up and had not exhibited any sign of osseous loss, implant mobility, or tumor recurrence. CONCLUSIONS The outcome of this case indicates that a microvascular graft and subsequent dental implantation is a good treatment plan that aids in a quick functional rehabilitation in ameloblastoma patients.
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Ameloblastoma: a clinical review and trends in management. Eur Arch Otorhinolaryngol 2015; 273:1649-61. [DOI: 10.1007/s00405-015-3631-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/15/2015] [Indexed: 12/22/2022]
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Abstract
Ameloblastoma is the second most common benign odontogenic tumour (Shafer et al. 2006) which constitutes 1–3% of all cysts and tumours of jaw, with locally aggressive behaviour, high recurrence rate, and a malignant potential (Chaine et al. 2009). Various treatment algorithms for ameloblastoma have been reported; however, a universally accepted approach remains unsettled and controversial (Chaine et al. 2009). The treatment algorithm to be chosen depends on size (Escande et al. 2009 and Sampson and Pogrel 1999), anatomical location (Feinberg and Steinberg 1996), histologic variant (Philipsen and Reichart 1998), and anatomical involvement (Jackson et al. 1996). In this paper various such treatment modalities which include enucleation and peripheral osteotomy, partial maxillectomy, segmental resection and reconstruction done with fibula graft, and radical resection and reconstruction done with rib graft and their recurrence rate are reviewed with study of five cases.
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Sasaki R, Watanabe Y, Ando T, Akizuki T. Two stage enucleation and deflation of a large unicystic ameloblastoma with mural invasion in mandible. Craniomaxillofac Trauma Reconstr 2014; 7:139-42. [PMID: 25050148 DOI: 10.1055/s-0033-1364197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 02/17/2013] [Indexed: 10/25/2022] Open
Abstract
A treatment for strategy of unicystic ameloblastoma (UA) should be decided by its pathology type including luminal or mural type. Luminal type of UA can be treated only by enucleation alone, but UA with mural invasion should be treated aggressively like conventional ameloblastomas. However, it is difficult to diagnose the subtype of UA by an initial biopsy. There is a possibility that the lesion is an ordinary cyst or keratocystic odontogenic tumor, leading to a possible overtreatment. Therefore, this study performed the enucleation of the cyst wall and deflation at first, and the pathological finding confirmed mural invasion into the cystic wall, leading to the second surgery. The second surgery enucleated scar tissue, bone curettage, and deflation, and was able to contribute to the reduction of the recurrence rate by removing tumor nest in scar tissue or new bone, enhancing new bone formation, and shrinking the mandibular expanding by fenestration. In this study, a large UA with mural invasion including condyle was treated by "two-stage enucleation and deflation" in a 20-year-old patient.
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Affiliation(s)
- Ryo Sasaki
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Police Hospital ; Department of Oral and Maxillofacial Surgery, Tokyo Women's Medical University, School of Medicine ; Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Yorikatsu Watanabe
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Police Hospital ; Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomohiro Ando
- Department of Oral and Maxillofacial Surgery, Tokyo Women's Medical University, School of Medicine
| | - Tanetaka Akizuki
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Police Hospital
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Mandibular reconstruction with autologous human bone marrow stem cells and autogenous bone graft in a patient with plexiform ameloblastoma. J Craniofac Surg 2014; 24:e409-11. [PMID: 23851884 DOI: 10.1097/scs.0b013e318292c91d] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Ameloblastoma is a histologically benign tumor, but it shows a tendency of locally aggressive behavior. To our knowledge, this is the first report of a successful reconstruction performed for treating a mandibular defect by using autologous human bone marrow mesenchymal stem cells in a patient with plexiform ameloblastoma. In this article, we report the result of the mandibular reconstruction with autologous human bone marrow mesenchymal stem cells and autogenous bone graft, followed by the placement of osteointegrated dental implant and prosthodontic treatment in a patient with plexiform ameloblastoma.
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Kim JD, Jang HS, Seo YS, Kim JS. A repeatedly recurrent desmoplastic ameloblastoma after removal and allobone graft: Radiographic features compared with histological changes. Imaging Sci Dent 2013; 43:201-7. [PMID: 24083215 PMCID: PMC3784681 DOI: 10.5624/isd.2013.43.3.201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 04/15/2013] [Accepted: 04/27/2013] [Indexed: 01/03/2023] Open
Abstract
A 40-year-old man suffered from a repeatedly recurrent desmoplastic ameloblastoma in the right maxillary anterior and premolar regions. During the first visit, the patient was provisionally histopathologically diagnosed with a developmental cyst, and it was confirmed to be unicystic ameloblastoma and resected. Four years later, the lesion recurred, and was diagnosed as a desmoplastic type of ameloblastoma and removed again. Then, 5 years after the second surgery, the lesion recurred again, and was diagnosed as a type containing a follicular pattern, recurrent ameloblastoma. A panoramic radiograph showed a multilocular and mixed radiolucent/radiopaque expansile lesion at the first visit, a unilocular cystic lesion confined to the premolar area at the second visit, and a small soap bubble appearance in the molar area in the final visit. Cone-beam computed tomographic images of the final recurrence of the tumor revealed multiple small cyst-like structures in the right maxillary anterior and posterior regions.
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Affiliation(s)
- Jae-Duk Kim
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Chosun University, Gwangju, Korea
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Catherine Z, Isaac S, Cotton F, Roch J, Rousset M, Bouletreau P, Breton P. [Giant ameloblastoma of the mandible]. ACTA ACUST UNITED AC 2013; 114:97-101. [PMID: 23838249 DOI: 10.1016/j.revsto.2013.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 09/06/2012] [Accepted: 01/04/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Giant ameloblastomas are more common in developing countries. They raise a serious problem of management. We present the case of one of the largest ameloblastoma ever reported. CASE REPORT A 48-year-old Congolese female patient was referred for mandibular swelling having begun 23 years before and now inducing severe functional disorders. A cephalic CT scan revealed a multicystic mass, 30×18×10cm in size, with a typical "soap bubble" presentation, and with thinned and inflated cortical bone. The treatment was sub-total segmental mandibulectomy with immediate reconstruction using a fibular free flap, modeled on the sampling site by four ostectomies. The pathological examination confirmed the diagnosis of a benign follicular and plexiform ameloblastoma. The excess of soft tissue was treated with a right commissuroplasty on the 15th postoperative day. There was no complication. DISCUSSION Radical treatment followed by immediate reconstruction using a free flap is the treatment of choice for giant mandibular ameloblastomas, when considering immediate functional and esthetic benefits. This is a prime concern for patients with a difficult access to health care and for whom long-term follow-up is not feasible.
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Affiliation(s)
- Z Catherine
- Service de stomatologie, chirurgie maxillo-faciale et chirurgie plastique de la face, centre hospitalier Lyon-Sud, 165 chemin du Grand-Revoyet, Pierre-Bénite, France
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Infante-Cossio P, Prats-Golczer V, Gonzalez-Perez LM, Belmonte-Caro R, Martinez-DE-Fuentes R, Torres-Carranza E, Gacto-Sanchez P, Gomez-Cia T. Treatment of recurrent mandibular ameloblastoma. Exp Ther Med 2013; 6:579-583. [PMID: 24137230 PMCID: PMC3786835 DOI: 10.3892/etm.2013.1165] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 05/28/2013] [Indexed: 11/05/2022] Open
Abstract
Ameloblastoma is a locally invasive benign odontogenic tumor with a high rate of recurrence in the long term. The authors conducted a retrospective study of patients with mandibular ameloblastoma in order to evaluate recurrent ameloblastoma management. The study included data from 31 patients over a period of 10 years. Data collected included age, gender, tumor location, histological findings, initial treatment, number of recurrences and year of onset, type of treatment of recurrence, reconstruction and follow-up. Recurrences were detected in nine patients (29%). Tumor recurrences appeared at 32 months on average following the initial surgical procedure. Recurrences were associated mainly to inadequate initial therapeutic approach and were treated by bone resection with a safety margin of at least 1 cm beyond the radiographically visible margins. Immediate reconstruction of bone defects was performed with grafts or free flaps.
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Affiliation(s)
- Pedro Infante-Cossio
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, Spain
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Mijiti A, Ling W, Maimaiti A, Moming A. Single-stage management of huge desmoplastic ameloblastoma of the anterior mandible. J Plast Reconstr Aesthet Surg 2013; 66:1440-1. [PMID: 23664801 DOI: 10.1016/j.bjps.2013.04.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/10/2013] [Accepted: 04/13/2013] [Indexed: 10/26/2022]
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Intraoral Microvascular Anastomosis for Segmental Mandibular Reconstruction Following Removal of an Ameloblastoma. J Craniofac Surg 2013; 24:e265-70. [DOI: 10.1097/scs.0b013e31828cbe80] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Askin SB, Aksu AE, Calis M, Tulunoğlu İ, Safak T, Tözüm TF. Report of multidisciplinary treatment of an extensive mandibular ameloblastoma with free iliac crest bone flap, dental implants, and acellular dermal matrix graft. J ORAL IMPLANTOL 2013; 41:107-11. [PMID: 23506101 DOI: 10.1563/aaid-joi-d-13-00003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Iliac Crest Flap for Mandibular Reconstruction After Advanced Stage Mandibular Ameloblastoma Resection. Ann Plast Surg 2012; 69:529-34. [DOI: 10.1097/sap.0b013e31821d06f3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bianchi B, Ferri A, Ferrari S, Leporati M, Copelli C, Ferri T, Sesenna E. Mandibular resection and reconstruction in the management of extensive ameloblastoma. J Oral Maxillofac Surg 2012; 71:528-37. [PMID: 23021893 DOI: 10.1016/j.joms.2012.07.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/06/2012] [Accepted: 07/06/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To present our experience with the management of 31 extensive mandibular ameloblastomas treated with segmental mandibulectomy, reconstruction with free fibula or iliac crest flap, and rehabilitation with immediate or delayed endosteal dental implants. PATIENTS AND METHODS The study sample comprised 31 patients with histologically confirmed mandibular ameloblastomas. Primary ameloblastomas were treated in 23 patients, and recurrent ameloblastomas affected 8 patients. Mandibular defect sizes ranged from 3.5 to 12.5 cm (mean, 5.6 cm). A free fibula osseous or osteocutaneous flap was used 17 times for reconstruction; in the remaining 14, a free iliac crest osseous or osteomuscular flap was chosen. Dental implants were positioned in 25 patients; implant procedures were performed simultaneously with reconstruction in 21 cases. RESULTS All flaps were transplanted successfully, and no major complication occurred postoperatively. Final histologic examinations showed 27 multicystic and 4 unicystic ameloblastomas. Free margins were achieved in all patients. The duration of follow-up was 18 to 120 months (mean, 53.6 months). No patient showed clinical or radiologic signs of recurrence. The dental implant success rate was 100%. CONCLUSIONS Segmental mandibular resection followed by immediate defect reconstruction with bone-containing free flaps with immediate dental implant placement should be considered as the treatment of choice for extensive mandibular ameloblastomas.
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Affiliation(s)
- Bernardo Bianchi
- Maxillo Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
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Abstract
In cases of reconstruction of a discontinuity defect of the mandible, the surgeon has a major responsibility to maximize function as well as cosmetics and to preserve quality of life, restoring mastication, speech, and appearance. Treatment of mandibular discontinuity defects is a complex process and, among other methods, includes the use of free vascularized flaps. A variety of donor sites have been used for this purpose, including the iliac crest, radius, scapula, and fibula.At this time, the iliac crest free flap represents a versatile reconstruction method after mandibular ablation. This article reports a clinical case using the iliac crest free flap for comprehensive reconstruction of discontinuity defects in the mandible after resections of an aggressive odontogenic tumor. The immediate implant positioning reduced the number of surgical procedures and the rehabilitation time.
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Koukourakis GV, Miliadou A, Sotiropoulou-Lontou A. Ameloblastoma, a rare benign odontogenic tumour: an interesting tumour review targeting the role of radiation therapy. Clin Transl Oncol 2012; 13:793-7. [PMID: 22082643 DOI: 10.1007/s12094-011-0735-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ameloblastoma is known as a benign, slow-growing, rare, odontogenic neoplasm. The solid/multicystic, the unicystic with a fibrous connective-tissue capsule and the peripheral ameloblastoma represent the three well distinguished clinical types of ameloblastoma. Surgical resection with an attempt to achieve adequate free margins constitutes a well documented and accepted treatment modality. Controversies exist, however, with regard to the extent of operative intervention. Patients with inadequate or positive surgical margins or unresectable lesions can be treated with radiation or combined radiation and chemotherapy. The authors present a review of this sparse disease focusing on the special role and efficacy of radiation therapy in its management.
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Affiliation(s)
- G V Koukourakis
- Second Department of Radiation Oncology, "Saint Savvas" Anticancer Institute of Athens, Athens, Greece.
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Minichetti JC, D'Amore JC, Schwarz E. Complete oral rehabilitation of a postresection ameloblastoma patient: a clinical case report. J ORAL IMPLANTOL 2011; 37:735-44. [PMID: 21955211 DOI: 10.1563/aaid-joi-d-11-00155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Conventional ameloblastomas are rare, benign, epithelial odontogenic tumors that tend to grow slowly in the mandible or maxilla, but are locally invasive and can be highly destructive of the surrounding dental anatomy. Aggressive resection is the most effective method of eliminating the tumors, but treatment can further contribute to patient deformity and malfunction. Ameloblastomas also have a high rate of recurrence, which significantly diminishes 8 years after resection, but still requires vigilant clinical monitoring. This case report describes the complete oral rehabilitation of a postresection ameloblastoma patient with a mandibular reconstruction plate and partial edentulism. An autogenous graft was taken from the patient's iliac crest, shaped to fit the defect, and attached with bone screws. After graft incorporation, dental implants were successfully placed into the augmented ridge and restored with a fixed partial denture. There was no evidence of tumor recurrence during the 10 months of treatment or 8 years of subsequent clinical monitoring.
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Masloub SM, Abdel-Azim AM, Elhamid ESA. CD10 and osteopontin expression in dentigerous cyst and ameloblastoma. Diagn Pathol 2011; 6:44. [PMID: 21609487 PMCID: PMC3118315 DOI: 10.1186/1746-1596-6-44] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 05/24/2011] [Indexed: 01/06/2023] Open
Abstract
Aims and Objectives To investigate the expression of CD10 and osteopontin in dentigerous cyst and ameloblastoma and to correlate their expression with neoplastic potentiality of dentigerous cyst and local invasion and risk of local recurrence in ameloblastoma. Methods CD10 and osteopontin expression was studied by means of immunohistochemistry in 9 cases of dentigerous cysts (DC) and 17 cases of ameloblastoma. There were 7 unicystic ameloblastoma (UCA) and 10 multicystic ameloblastoma (MCA). Positive cases were included in the statistical analysis, carried on the tabulated data using the Open Office Spreadsheet 3.2.1 under Linux operating system. Analysis of variance and correlation studies were performed using "R" under Linux operating system (R Development Core Team (2010). Tukey post-hoc test was also performed as a pair-wise test. The significant level was set at 0.05. Results High CD10 and osteopontin expression was observed in UCA and MCA, and low CD10 and osteopontin expression was observed in DC. Significant correlation was seen between CD10 and osteopontin expression and neoplastic potentiality of DC and local invasion and risk of recurrences in ameloblastoma. Conclusions In DC, high CD10 and osteopontin expression may indicate the neoplastic potentiality of certain areas. In UCA & MCA, high CD10 and osteopontin expression may identify areas with locally invasive behavior and high risk of recurrence.
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Affiliation(s)
- Shaimaa M Masloub
- Oral Pathology Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Tözüm TF, Sönmez E, Askin SB, Tulunoglu I, Safak T. Implant stability and peri-implant parameters in free vascularized iliac graft transplantation patients: report of three ameloblastoma cases. J Periodontol 2010; 82:329-35. [PMID: 20932154 DOI: 10.1902/jop.2010.100339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Ameloblastoma, a benign but locally aggressive tumor, accounts for 9% to 11% of all odontogenic tumors. Radical procedures, including resection, are performed. To restore functions after resection, free vascularized iliac grafts followed by a dental implant-supported prosthesis are used as a successful treatment option. The aim of this case report is to evaluate the peri-implant clinical status and stability of dental implants placed in patients with advanced-stage mandibular ameloblastomas. METHODS Examinations of three patients revealed extensive ameloblastomas, and hemimandibulectomies were performed. Six months after surgeries, two to four dental implants were placed. After 6 months of healing, one fixed prosthesis and two removable prostheses were delivered. The stability of implants was evaluated at the surgical baseline and 1, 3, 6, 9, and 12 months after surgery by resonance-frequency (RF) analysis. Peri-implant clinical parameters (i.e., plaque index [PI], gingival index [GI], gingival bleeding time index [GBTI], and peri-implant probing depth [PD]) were recorded at the delivery of the prosthesis and at follow-ups at 1, 3, and 6 months. RESULTS Nine implants that supported one removable prosthesis and two fixed prostheses were placed. RF analysis revealed no significant changes in implant stability during 12 months of follow-up. Peri-implant clinical parameters (PI, GI, and GBTI) showed slight improvements during follow-up. Although advancements were observed in 6 months, PDs were found to be deeper than optimal measurements for the whole observation time. CONCLUSION The implant-supported prosthetic rehabilitation of patients with ameloblastomas reconstructed with free vascularized iliac crest grafts can be a predictive alternative for improving the quality of life of patients in which a high implant stability and acceptable peri-implant health may be achieved.
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Affiliation(s)
- Tolga F Tözüm
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
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Shen LC, Chen YK, Hsue SS, Shaw SY. Expression of osteonectin/secreted protein acidic and rich in cysteine and matrix metalloproteinases in ameloblastoma. J Oral Pathol Med 2010; 39:242-9. [DOI: 10.1111/j.1600-0714.2009.00862.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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A treatment algorithm for managing giant mandibular ameloblastoma: 5-year experiences in a Paris university hospital. Eur J Surg Oncol 2009; 35:999-1005. [DOI: 10.1016/j.ejso.2009.04.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 04/01/2009] [Accepted: 04/03/2009] [Indexed: 11/17/2022] Open
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Kalavrezos N, Baldwin DJ, Walker DM. Giant neglected ameloblastoma: single stage treatment and clinicopathological review. Br J Oral Maxillofac Surg 2008; 46:591-3. [DOI: 10.1016/j.bjoms.2008.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2008] [Indexed: 11/30/2022]
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