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AMELOBLASTOMA JORNADA.ppt
- 1. AMELOBLASTOMA. REVIEW OFTHE TUMOR AND CLINICAL CASE PRESENTATIONS Authors: 1. Dr. Ernesto Carmona Fernandez First degree Specialist in Maxillofacial Surgery Master in Dentistry Urgencies. OSHAKATI STATE HOSPITAL. NAMIBIA August 2019
- 2. OUTLINE Definition Epidemiology Classifications Radiological features Management Prognosis Differential diagnosis Conclusions
- 3. DEFINITION • It isa benign tumor of odontogenic origin, derived from odontogenic epithelium which is locally invasive, intermittent in growth, clinically persistent & with a strong tendency to recur.
- 4. EPIDERMIOLOGY • It accountsfor 1% of oral tumors & 18% of odontogenic tumors. • It is prevalent in Africans has no sex predilection • Prevalent between 20-50 years
- 5. ETIOLOGY ♦♦♦Traumatic episodes: Extraction,cystectomy, fractures ♦Chronic Infections ♦Dietary deficiency: vitamin D deficiency, Lack of protein intake ♦Virus infection: HPV ETIOLOGY
- 6. They may arisefrom: Rests of dental lamina A developing Enamel Organ The epithelial lining of an Odontogenic Cyst The basal cells of the oral mucosa The epithelial cell rests of Malessez
- 7. CLINICAL CLASIFICATION • SolidAmeloblastoma • Cystic Ameloblastoma • Peripheral Ameloblastoma • Pituitary Ameloblastoma • Malignant Ameloblastoma
- 8. WHO CLASIFICATION • Solid/ Multicystic • Extraosseous or Peripheral • Unicystic • Desmoplastic
- 9. HISTOPATHOLOGICAL FEATURES I. Follicular II.Plexiform III. Acanthomatuos IV. Granular cell V. Desmoplastic VI. Basal cell The follicular and plexiform patterns are the most common No correlation between clinical behavior and these microscopic patterns
- 10. ■ Age: 20-50years ■ Sex: No significant sex predilection ■ Race: More common in blacks than in white race. ■ Site: Mandible > maxilla(more than 80% mandible) ■ With in mandible molar ramous area is affected three times more commonly than premolars & anterior region. CLINICAL FEATURES
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- 12. CLINICAL FEATURES • Asymptomatic,slow growing, hard consistency • Non tender to palpation • Ovoid swelling. • May be associated with mobile teeth, • exfoliation of teeth, expansion of bone cortices, • thinning out bone, ill fitting dentures, malocclusion, paresthesia or ulcerations. • May become secondarily infected & painful as a result • Large lesions may present with pain • The malignant variants show clinical features of malignancy: pain, ulceration, infiltration, rapid growth, metastasis
- 13. RADIOGRAPHIC FINDINGS • Ameloblastomasare osteolytic & present as unilocular or multilocular. • Well circumscribed by bony radiopaque borders • Margins are usually well defined & sclerotic
- 14. RADIOGRAPHIC FINDINGS • Rootresorption & tooth displacement. • Displacement of the neurovascular bundle • Cortex shows thinning and often severe expansion • Involvement of the antrum is seen as an opacification.
- 16. 1. Dentigerous Cyst:Unilocular, Multilocular 2. Central Giant Cell Granuloma: honeycomb multilocular appearance 3. Odontogenic Keratocyst: unilocular lesion with smooth, corticated border 4. Odontogenic Myxoma: Soap bubble pattern 5. Residual Cyst: Unilocular 6. Aneurysmal Bone Cyst: Unilocular 7. Interosseous Hemangioma: sclerotic well demarcated borders DIFFERENTIAL DIAGNOSIS
- 17. MANAGEMENT • No singlestandard type of therapy advocated • Depends on the age & general health of the patient, the growth pattern of the tumor, the various physical forms, whether cystic, solid, extraosseous or malignant. • Also depends on the duration, anatomical site of the lesion, clinical size & extent, local behavior, virgin or already treated before, therapy available and working conditions.
- 18. MANAGEMENT • Complete eradicationof the lesion is required with reconstruction of the resultant defect. • Cystic ameloblastoma is treated less aggressively by enucleation The solid lesions require at least excision because recurrence follows in 50% to 90% of cases. • Block excision or resection is reserved for larger lesions
- 19. MANAGEMENT Resection couldbe marginal without continuity defect, segmental with continuity defect, hemimandibulectomy with or without disarticulation, subtotal mandibulectomy & total mandibulectomy. Peripheral ameloblastoma should be treated in a conservative fashion while malignant lesions should be managed as carcinomas
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- 21. MANAGEMENT • The characteristicfeature of this tumor is that it microscopically infiltrates bone beyond the tumor-bone interface seen in imaging so a safe margin of uninvolved bone (1.5cm-2cm) should be removed when resecting. • If complete excision of the tumor is ascertained by clinical & radiographic examination then immediate reconstruction can be carried out
- 22. MANAGEMENT • Immediate reconstructioncan be done by using autogenous free bone grafts (Iliac or rib graft) or bank allogenic bone crib and autogenous bone marrow with a reconstruction plate. • Reconstruction plate with or without condylar prosthesis can be used in cases where secondary reconstruction is planned, where adequate soft tissue coverage is not available or in very old patients • In cases where there is insufficient soft tissue locally, a vascularized composite pedicle graft of bone & myocutaneous tissue can be used
- 23. • It maybe extremely disfiguring ,fungating and ulcerative like carcinoma • Invades surrounding tissues • Bone destruction • Root resorption • Asymmetry • Proptosis • Severe pain • Difficulty breathing • Ill fit dentures • Loss of teeth IN THE ABSENCE OF TRETMENT
- 24. PROGNOSIS • Prognosis ofameloblastoma is good as long as management of the lesion is carried out appropriately with follow-up afterwards.
- 25. EXTRAORAL VIEW Diffuse swellingover the right side of the face, firm to palpation
- 26. INTRAORAL EXAMINATION. (revealing adiffuse swelling from tooth 35 to the mandibular ramus, with expansion of bone cortices)
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- 28. SURGICAL DEFECT AFTERREMOVAL
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- 33. 09/30/17 www.stuffamia.com EXTRAORAL VIEW Diffuse swellingover the right side of the face, firm to palpation
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- 35. PANORAMIC VIEW (revealed alarge multilocular radiolucent area extending from the 44 to the right coronoid process including the ascending ramus area)
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- 37. IMAGE OF THETUMOR
- 38. SURGICAL DEFECT AFETEREXCISSION
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- 40. WOUND CLOSURE BYLAYERS
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- 46. WOUND CLOSURE BYLAYERS
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- 56. 09/30/17 www.stuffamia.com MANDIBLE RECONSTRUCTION WITHTITANIUN PLATE
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- 96. CONCLUSIONS • Ameloblastoma hasa recurrence rate of up to 50% during the first five years postoperatively and as such long term follow-up is a must. • Treatment of these tumors require experience, training and working conditions to restore proper function and appearance of the patients.
- 97. REFERENCES • Textbook oforal & maxillofacial surgery (3rd edition)by Neelima Anil Malik • Oral Pathology (5th edition) by Regezi, Scuibba & Jordan • Textbook of oral pathology by Sanjay Saraf • Burket’s oral medicine, diagnosis & treatment (12th edition)
- 98. 09/30/17 www.stuffamia.com ““ Imagination ismore important than knowledge, for knowledge is limited while imagination embraces the entire world.” Albert Einstein
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