3. A benign odontogenic epithelial neoplasm that
histologically mimics the embryonal enamel
organ but does not differentiate from it to the
point of forming dental hard tissues; it behaves as
a slowly growing expansile radiolucent tumor,
occurs most commonly in the posterior regions of
the mandible and tends to recur if inadequately
excised.
Ameloblastoma is listed as a "rare disease"
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4. Ameloblastoma is a rare disorder that
affects males and females in equal
numbers. It affects persons of all ethnic
age groups.
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5. The cause of ameloblastoma is not understood.
Causes may include injury to the mouth or
jaw, infections of the teeth or gums, or
inflammation of these same areas. Infections
by viruses or lack of protein or minerals in the
persons diet are also suspected of causing the
growth or development of these tumors. In
general, however, scientists do not
understand the cause of cysts and tumors, nor
the reasons why they can become malignant.
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6. Clinically, ameloblastoma appears as an aggressive
odontogenic tumour, often asymptomatic and slow
growing, with no
evidence of swelling.
It can sometimes cause symptoms such as swelling,
dental malocclusion, pain and paresthesia of the
affected area.
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7. It represents approximately 1% of oral tumours; 80%
of ameloblastomas occur in the mandible and the
remaining 20% in the upper jaw.
The area of the mandible that is most affected is the
third molar region.
Usually presents between ages 30 and 50 .
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8. Radiografically , ameloplastoma typically form rounded ,
cyst like , radiolucent area with moderately well defined
margins and topically appear multilocular or with
a honey comb pattern . Lingual expansion may
sometimes be seen, but is not pathognomonic of
ameloplastoma . However , differentiation from non-neoplastic
cyst and other tumoursor tumour-like lesions
of the jaws is not possible by radiography alone .
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9. Lateral oblique radiograph of the mandible shows an expansile, multilocular, lucent
lesion with coarse internal trabeculae and displacement of teeth and adjacent structures.
The differential diagnosis includes odontogenic keratocyst
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10. Axial CT image bone window shows expanded ameloblastoma, intact cortical bone
buccally (arrow) and destroyed bone lingually
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11. CT-Scan axial projection for mandible:
bone window
showes swelling of the right lower mandible and demonstrate an expansive "cystic"
lesion with some adjacent sclerotic change. The appearance is compatible with a
mandibular ameloblastoma.
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12. Pre-apical digital image for right side of mandible
Bisecting technique
multilocular radiolucency in posterior region of mandible
Both second and third molars appear with roots resorption (external resorption)
Well-circumscribed, soap-bubble
Absent of lamina dura in the area of absorption
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13. While chemotherapy, radiation therapy, curettage and liquid
nitrogen have been effective in some cases of
ameloblastoma, surgical resection or enucleation remains
the most definitive treatment for this condition. In a
detailed study of 345 patients, chemotherapy and radiation
therapy seemed to be contraindicated for the treatment of
ameloblastomas. Thus, surgery is the most common
treatment of this tumor. Because of the invasive nature of
the growth, excision of normal tissue near the tumor
margin is often required.
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14. Some have likened the disease to basal cell carcinoma
(a skin cancer) in its tendency to spread to adjacent bony
and sometimes soft tissues without metastasizing. While
not a cancer that actually invades adjacent tissues,
ameloblastoma is suspected to spread to adjacent areas of
the jaw bone via marrow space. Thus, wide surgical
margins that are clear of disease are required for a good
prognosis. This is very much like surgical treatment of
cancer. Often, treatment requires . excision of entire
portions of the jaw.
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