FOLLICULAR AMELOBLASTOMA

Presented by : Dr Vinit Pandhi Post Graduate Student Dept. Of Oral And Maxillofacial Surgery

 An Incisional biopsy was performed from left buccal vestibule.

Histopathological examination showed features suggestive of FOLLICULAR AMELOBLASTOMA.

Based on case-history , clinical and radiographic findings and histo-pathological diagnosis a treatment plan was formulated.

 Treatment plan Left Hemi-maxillectomy from right lateral incisors to left retro molar region with a combined extra oral and intra oral approach. Immediate reconstruction with temporalis myofacial flap.

 Operative procedure Intubation carried out via the nasotracheal route. Throat pack was placed. Patient was scrubbed and draped in usual aseptic manner. Local anesthesia was administered at the operative site.

Weber Ferguson Approach

Intra Oral Approach

Lesion Exposed

Lesion Excised

Al Kayat Bramely Incision

Temporalis Myofascial Flap Reconstruction

Temporalis Myofascial Flap Reconstruction

1 week Follow up

1 Month Follow Up

2nd Month Follow Up

Prosthetic Rehabilitation

2nd Month Follow Up

 High recurrence rate observed in marsupalization (45.5%) followed by enucleation (18.2%).

Recurrence of 7.1% following radical surgery.

Histopathological variants and recurrence : Unicystic : 7.4% Multicystic : 52.4% Solid type : 6.8%
Comparison of long-term results between different approaches to Ameloblastoma :Norifumi Nakamura, et all : Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:13-20

 Histological sectioning of resected mandible containing ameloblastoma shows that ameloblastoma cells can be found up to 8 mm from the radiographic and clinical margin of the lesion.
Surgical resection with 1-cm margins in bone and a margin of one tissue plane in soft tissue is associated with a recurrence rate close to zero.

Is there a role for enucleation in the management of ameloblastoma ? M. A. Pogrel, et all: Int. J. Oral Maxillofac. Surg. 2009; 38: 807812.

 The pedicled temporalis myofascial flap is the simplest, most versatile, and readily available source of well-vascularized soft-tissue cover for the maxillectomy defect.

Sagittal muscle splitting therefore obviates the need for an additional pedicled or free flap.

Immediate reconstruction following maxillectomy: a new method. lnt. J. Oral Maxillofac. Surg. 1993; 22: 221-225.

 Temporalis muscle flap can be considered as a first-line reconstructive option for limited resection of the upper maxilla with sparing of the orbital floor and of the anterior alveolar crest.

Temporalis myofascial flap in maxillary reconstruction: anatomical study and clinical application. Dallan I, et all. J Craniomaxillofac Surg. 2009 Mar;37(2):96-101.

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