This document discusses ameloblastoma, a benign odontogenic tumor. It defines ameloblastoma and describes its clinical and histological classifications. The most common types are multicystic (86%) and unicystic (13%) ameloblastomas. The document outlines the clinical features, locations, and biological behavior of different ameloblastoma types. It also discusses various surgical treatment options for ameloblastoma, including curettage, enucleation with cauterization, wide excision, and segmental resection with reconstruction.

1. Good
Morning

2. Ameloblastoma ???Ameloblastoma ???
Presented by:
Dr. Abdul Qahar Qureshi
(PG Student)

3. IntroductionIntroduction
 Ameloblastoma –Ameloblastoma – Ivey and ChurchhilIvey and Churchhil (1934)(1934)
 Adamantinoma -Adamantinoma - MalassezMalassez (1885)(1885)
 An odontogenic tumor reported since 1826An odontogenic tumor reported since 1826

4. Definition:
Ameloblastoma as“ a odontogenic epithelial tumor
that is usually unicentric, nonfunctional, intermittent in
growth, anatomically benign and clinically persistent”.
– Robinson-1937
The Ameloblastoma is a true neoplasm of the enamelThe Ameloblastoma is a true neoplasm of the enamel
organ type tissue which does not undergo differentiationorgan type tissue which does not undergo differentiation
to the point of enamel formation.to the point of enamel formation.
-WHO-WHO

5. • Clinical ClassificationClinical Classification
Multicystic or conventional solid ameloblastoma – 86%
Unicystic ameloblastoma – 13%
Peripheral or extraosseous ameloblastoma - 1%
Malignant ameloblastoma
Ameloblastic carcinoma
Pituitary ameloblastoma

6.  Radiological ClassificationRadiological Classification
Lagundoye et al (1975) classified as
Multiloculated – multicystic
Unilocular
Septate- trabeculated Solid.

7. Histological classification:Histological classification:
 Plexiform typePlexiform type
 Follicular typeFollicular type
 AcanthamatousAcanthamatous
 GranularGranular
 DesmoplasticDesmoplastic
 Basal cell typeBasal cell type
 UnicysticUnicystic
 Plexiform unicysticPlexiform unicystic

8. Multicystic AmeloblastomaMulticystic Ameloblastoma
Clinical Features
•Recur multiple times & can metastasize
•Older group of patients
•Average age presentation: 32.7 - 44 yr.
•Majority of cases involve the mandible
•Kameyama et al: 23:1 ratio of mandibular to maxillary
ameloblastomas

9. Unicystic AmeloblastomaUnicystic Ameloblastoma
Clinical features
•Robinson & Martinez 1977
•May be associated with an unerupted tooth
Age & Location
Average age: 19.4 yr. To 27.7 yr.
•Almost exclusively in the mandible (few cases in the
maxilla)
•More than 2/3 of the lesion occur in the molar-ramus
region of the mandible
•Molar ramus area: 78% - 75%
•Symphysis area: 13%
•Cuspid-premolar area: 9.7% - 25%

10. Peripheral AmeloblastomaPeripheral Ameloblastoma
Clinical Features
•Uncommon lesion
•More frequent in the mandible than in the maxilla (2:1)
•Male to female ratio of 1.6:1
•Mean age of diagnosis: 53 yr
•Painless, sessile, firm, exophytic lesion
•Occurs in the soft tissue overlying the alveolar bone
•There is not direct bone involvement, but signs of erosion
or cupping may appear in response to the tumor growth

11. Malignant AmeloblastomaMalignant Ameloblastoma
Clinical Features
•Rare lesion
•Almost exclusively in the mandible
•Male to female ratio of 1.8:1
•Mean age of diagnosis: 28-32 yr.
•Common sites for metastasis : lungs (75%) spleen, kidney
& ileum

12. Biological behaviourBiological behaviour
 Benign,Benign,
 Locally aggressive,Locally aggressive,
 Infiltrative odontogenic neoplasm ,Infiltrative odontogenic neoplasm ,
 Rare capacity to metastasize,Rare capacity to metastasize,
 Notorious tendency to recur.Notorious tendency to recur.

13.  Low grade malignant.Low grade malignant.
 Asymptomatic .Asymptomatic .
 Tooth eruption and dental occlusion disturbance,Tooth eruption and dental occlusion disturbance,
tooth mobility and root resorption.tooth mobility and root resorption.
 Either jaw - posterior maxilla or molar ramus area.Either jaw - posterior maxilla or molar ramus area.
 Growth Pattern:- Bucco linguallyGrowth Pattern:- Bucco lingually

14.  The medullary extension with intact cortex isThe medullary extension with intact cortex is
not an uncommon findingnot an uncommon finding
 Grows by bone expansion rather than boneGrows by bone expansion rather than bone
destruction.destruction.
 Aggressively invade adjacent and regionalAggressively invade adjacent and regional
tissues.tissues.
 Metastasize to the bronchopulmonary system,Metastasize to the bronchopulmonary system,
local and distant lymph nodes, and distantlocal and distant lymph nodes, and distant
organs.organs.

15. Surgical optionsSurgical options
 CurettageCurettage
 Enucleation and CauterizationEnucleation and Cauterization
 Wide excisionWide excision
 Resection (segmental or en bloc) andResection (segmental or en bloc) and
reconstructionreconstruction

16.  Carlson and MarxCarlson and Marx ( JOMS 64: 2006) have( JOMS 64: 2006) have
rekindled the clinical controversy in therekindled the clinical controversy in the
surgical management of ameloblastoma.surgical management of ameloblastoma.
i.i. Assessing anatomic barrierAssessing anatomic barrier
ii.ii. Resection with 1 to 1.5 cm linear bone marginsResection with 1 to 1.5 cm linear bone margins
iii.iii. The use of specimen radiographsThe use of specimen radiographs
iv.iv. The use of frozen section of medullary portion of the stumpThe use of frozen section of medullary portion of the stump
 TheirTheir recommended protocolrecommended protocol for surgicalfor surgical
managemant of multicystic ameloblastom was;managemant of multicystic ameloblastom was;

17.  Multilocular ameloblastomaMultilocular ameloblastoma --SegmentalSegmental
resection and reconstructionresection and reconstruction
 Desmoplastic ameloblastomaDesmoplastic ameloblastoma -- Wide excisionWide excision
and partial maxillectomy.and partial maxillectomy.
 Unilocular ameloblastomaUnilocular ameloblastoma -- Enucleation andEnucleation and
Cauterization.Cauterization.

18. ReferrencesReferrences
 Unisystic Ameloblastoma of Mandible(1997)Unisystic Ameloblastoma of Mandible(1997)
 Peripheral Ameloblastoma(1994,1995)Peripheral Ameloblastoma(1994,1995)
 Marsupialization of cystic ameloblastoma(1995)Marsupialization of cystic ameloblastoma(1995)
 The Ameloblastoma:Primary, Curative SurgicalThe Ameloblastoma:Primary, Curative Surgical
Management.Management.Eric R. Carlson and Robert E. MarxEric R. Carlson and Robert E. Marx
 Oral Pathology- NavilleOral Pathology- Naville
 Wood and GoazWood and Goaz
 Daniel M LaskinDaniel M Laskin
 Shafer’s Oral PathologyShafer’s Oral Pathology
 ArcherArcher