AMELOBLASTOMA

Amelobalstoma
A benign, aggressive tumor that is invasive and persistent. solid or multicystic ameloblastoma Adult most commonly affected Mandibular molar- ramus most commonly affected site Broad range age range: mean 40 years old Unilocular or Multilocular Recurrence rate higher with conservative treatment No gender predilection They grow quickly and can change and destroy bone around them

Radiographic features

Clinical Features

Clinical Features

Types Of Ameloblastoma

SOLID/ MULTICYSTIC AMELOBLASTOMA

HISTOPATHOLOGICAL SUBTYPES OF SOLID AMELOBLASTOMA

FOLLICULAR
Islands of epithelium resemble dental organ surrounded by mature connective stroma.Individual follicles show central mass of stellate reticulum like cells surrounded by a single peripheral layer of ameloblast like cells. Nuclei of peripheral cells are reversely polarized. Within the islands, cyst formation is common.

PLEXIFORM Instead of islands, long, anastomosing cords

and occasional sheets of epithelial cells bounded by columnar cuboidal cells.Cells within cords are more loosely arranged than peripheral cells.Supporting stroma is loose and vascular. Cyst formation occurs, not inside follicles, but in surrounding stroma.

Types Of Ameloblastoma

SOLID/ MULTICYSTIC AMELOBLASTOMA

HISTOPATHOLOGICAL SUBTYPES OF SOLID AMELOBLASTOMA

ACANTHOMATOUS Central area of follicles show extensive squamous metaplasia, often associated with keratin formation.Does not indicate a more aggressive course of tumor Can be confused with squamous cell carcinoma. GRANULAR CELL Follicles / sheets of cells show granular cell change.These cells have abundant cytoplasm filled with eosinophilic granules.Seen in younger persons and appears to be more aggressive clinically

Types Of Ameloblastoma

SOLID/ MULTICYSTIC AMELOBLASTOMA

HISTOPATHOLOGICAL SUBTYPES OF SOLID AMELOBLASTOMA BASAL CELL TYPE Least common type Composed of nests /sheets of hyperchromatic basaloid cells. No stellate reticulum present centrally and peripheral cells tend to be cuboidal rather than tall columnar

UNICYSTIC AMELOBLASTOMA SUBTYPES OF UNICYSTIC AMELOBLASTOMA

LUMINAL Tumor is confined to luminal surface of cyst.Seen as fibrous cyst wall with lining comprised totally / partially of ameloblastic epithelium, showing a basal layer of columnar / cuboidal reversely polarized cells .Overlying epithelial cells are loosely adhesive, resembling the stellate reticulum of dental organ.

Types Of Ameloblastoma

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UNICYSTIC AMELOBLASTOMA SUBTYPES OF UNICYSTIC AMELOBLASTOMA

INTRALUMINAL

This variant shows the tumor from cyst lining protruding into the lumen of cyst. Intraluminal projections resemble plexiform ameloblastoma in most cases, though not always.
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MURAL

In this type, the fibrous wall of the cyst is infiltrated with typical follicular / plexiform ameloblastoma. Believed to be more aggressive than other two variants

Definition of terms

Ameloblastoma - is a benign odontogenic tumor arising from the residual epithelial components of tooth development Hemimandibulectomy- is a procedure whereby one half of the mandible is removed surgically. Reconstruction of the mandible - mandible is to restore the shape and function of the face, the continuity of the mandible and the muscular attachment Osteotomy is a surgical procedure that involve bonecutting. Incision- cutting or surgical cut in the skin or flesh Hemostasis stop blood Gigli Saw - is another instrument used to carry out osteotomy. The instrument has two handles, and a lengthwise twisted stainless-steel wire is hooked to them. Suture is a process of joining two surfaces or edges together along a line by or as if by sewing.

Patients Information
16 M Student Filipino

years old

Complete Patient History

Chief Complain
May

pamamaga po sa aking baba

There

is swelling at my jaw.

History of Present Illness

The

patient has history of incision and drainage three years ago and comes for consult because of the swelling at the left side of his mandible. He was put on antibiotics for a week but notices there no change. The swelling is still not healing after a week .There is also minimal displacement of the teeth. The patient requested X-ray examination of his left mandible.

Medical History

Never

been hospitalized Not taking any medications Does not have any allergies

Dental History
No

Restorations No Extractions History of incision and drainage

Social History
He

doesnt smoke and he doesnt drink alcohol

Patients DENTAL CHART

Diagnostic Findings

Diagnosis
Preliminary

Diagnosis : Ameloblastoma Diagnosis : Ameloblastoma Diagnosis : Odontogenic Keratocyst

Tentative

Differential

AMELOBLASTOMA Anameloblastomais a benign but locally agressivetumour arising from the mandible, or less commonly from the maxilla. Epidemiology Ameloblastomas are the second most common odontogenic tumor andaccount for up to a 3rdof such cases. They are slow growing and tend to present in the 3rdto 5thdecades of life, with no gender predilection Pathology , responsible for enamel production and eventual crown formation). Ameloblastomas (not surprisingly) arise from ameloblasts, (part of the odontogenic epithelium Radiographic Features Typically rounded. Radiographic margins are usually well defined and sclerotic. Multilocular radiolucencyScalloped margin.When loculations are large, the appearance is called as SOAP BUBBLEappearance

ODONTOGENIC KERATOCYST Anodontogenickeratocyst (OKC)is a type of developmental cyst involving the mandible or maxilla. Epidemiology Odontogenickeratocysts typically present in younger patients (2nd- 3rddecades), are often multiple, and may be seen in either the body or ramus of mandible (approximately 70% of all OKCs), ormaxilla. There may be male predilection. Pathology OKCs originate from epithelial cell rests (stratified squamous keratinizing epithelium) found along the dental lamina and periodontal margin of the alveolus of the mandible. Radiographic Features Well defined radiolucent area Rounded or scalloped margin Some are unilocular but majority are multilocular

Treatment

HEMIMANDIBULECTOMY And RECONSTRUCTION of MANDIBLE

Hemimandibulectomy
Before Surgery : Evaluate any other medical problems Pulmonary function test (PFT) Cardiac stress test to evaluate your heart. Anesthetic Requirements GENERAL ANESTHESIA

Surgical Procedures Hemimandibulectomy Incision

Surgical Procedures Hemimandibulectomy Hemostasis

Surgical Procedures Hemimandibulectomy Occlusion Setting with wiring

Surgical Procedures Hemimandibulectomy Resection of Mandible with the lesion

Reconstruction of mandible
Placement

of titanium plates with bone graft ( fibula,illiac and others)

Reconstruction of mandible
Placement

of titanium plates without bone

graft

Suturing

After Surgery

Tubes, drains, catheters, and other medical devices. Humidifier Collar ( Tracheostomy ) IV Foley Catheter Feeding tube ( Nasogastric Tube Feeding) Self - Care Oral Irrigation Diet Follow-up Appointments

Complications
Blood

clot Speech and swallowing Bleeding Numbness Infection