Ameloblastoma of the jaws in adult: A retrospective review of local recurrent lesions based on the resection margin in the adjacent apparent healthy tissues

Classification and prognostic evaluation of ameloblastoma using multiplanar CT imaging: a retrospective analysis

BACKGROUND

Ameloblastoma is the most prevalent odontogenic tumor of the jaw, with a significant recurrence rate. It was conventionally classified radiographically as unilocular or multilocular. As 3D images become more common, there is a need to reassess this classification. This study aimed to conduct a multi-planar assessment of ameloblastoma using CT images, reclassify the lesions based on locularity, and correlate the locularity with imaging characteristics and recurrence.

METHODS

Panoramic radiographs and CT images of histopathologically confirmed 255 ameloblastoma patients were included. The analysis encompassed imaging features including locularity, expansion, thinning, cortical perforation, and root resorption. Image characteristics associated with recurrence rate were examined, and image features were assessed based on locularity.

RESULTS

On panoramic radiographs, most ameloblastomas (68.6%) were classified as multilocular, while 31.4% were unilocular. The CT scan demonstrated that 46.3% of the ameloblastomas were pseudo-multilocular, 29.4% were unilocular, and 24.3% were multilocular. Multilocular cases on panoramic radiographs often appeared as pseudo-multilocular on CT. Cortical perforation, root resorption, and size were significantly correlated with CT locularity types (p < 0.05). The recurrence rate was 14.11%, and the risk of recurrence was substantially reduced by mandibulectomy and a larger tumor size. No other variables were significantly related to recurrence.

CONCLUSION

An accurate diagnosis of ameloblastoma and surgical planning to reduce the recurrence rate are contingent upon the use of three-dimensional imaging modalities, such as CT.

Surgical management of conventional ameloblastoma: a retrospective cohort study over the past 21 years

Conventional ameloblastoma presents infiltrative behavior and its treatment ranges from enucleation combined with adjuvant therapies to marginal/segmental resection. The purpose of this study is to present a cohort of twenty-four patients with ameloblastoma treated in the same institution after marginal/segmental resection for the past 21 years. All cases had diagnosis confirmation by incisional biopsy. Patients with an unconfirmed diagnosis and missing follow-up information were excluded. Data were categorized into clinicopathological, surgical and recurrence aspects. Thirteen patients were females (54%). The mean age was 40.2 years. Mandible was the most affected site (91%). The mean length of the lesions was 4.10 cm (± 2.06) and the multilocular aspect was predominant (83%). Root resorption (37.5%), tooth displacement (45.8%) and cortical perforation (45.8%) were noticed. Histologically, most of the cases were follicular (n = 19,79%). Microscopic analysis showed positive margins in four cases. Patients were treated by marginal (n = 19) and segmental (n = 5) resections. Recurrence occurred in two cases (8.33%). Both primary and recurrent ameloblastomas were treated through marginal resections and no recurrence was observed during the past 9 and 5 years after the last intervention, respectively. The overall mean follow-up was 79.25 months and patients are still monitored over these years. Marginal/segmental resection of conventional ameloblastoma is associated with a low recurrence rate.

Treatment of benign maxillomandibular osteolytic lesions larger than 4 cm: A systematic review

OBJECTIVE

This systematic review aimed to assess the different treatments of benign maxillo-mandibular radiolucent bone lesions over 4 cm to propose a management algorithm.

STUDY DESIGN

A literature search was conducted using MEDLINE/PubMed, Scopus, Google Scholar, Virtual Health Library databases, and gray literature. Randomized or non-randomized clinical trials and case series with 10 or more patients with a minimum follow up of 1 year, published in French or English until August 2023, were included. The risk of bias was assessed for all papers included.

RESULTS

Of 1433 records identified, 22 were included in this review, reporting data from 1364 lesions. Ameloblastoma was the most common lesion (51.22%) and mandible was the most common site (81.21%). Initial conservative treatment was prevalent (71.04%). Recurrence was higher after conservative (13.8%) than after radical treatments (6.5%). Multilocularity, cortical perforation, dental element preservation were linked to a higher recurrence risk.

CONCLUSION

This study has shown importance of understanding specific characteristics and recurrence risk in benign maxillomandibular osteolytic lesions. Multidisciplinary team approval, personalized approach based on lesion type and patient are crucial. The presence of at least one risk factor could lead to therapeutic decision. Despite limitations, the study informed lesion management and provided precise recommendations.

Recurrence and malignant risk of ameloblastoma: A demographic study of 1626 cases from east China

BACKGROUND

Ameloblastoma is characterized by aggressive nature, high recurrence rate, occasional malignant transformation, but recurrence and malignant incidence of ameloblastoma are not yet addressed by a large-scale case series study.

MATERIALS AND METHODS

This study provided a detailed description of the relationship between demographic characteristics and recurrence and malignant cases with different clinical types of ameloblastoma (n = 1626).

RESULTS

The overall incidence of recurrence and malignancy was 17.2 % and 3.4 %, respectively. Notably, we observed that there were multiple recurrent episodes (mean time, 24.3-28.7 months) among ameloblastoma patients. Multivariate analysis revealed that age of > 45 years (odds ratios (OR), 2.10; 95 % confidence interval (CI), 1.17-3.76), male (OR, 3.24; 95 %CI, 1.49-6.99), maxilla (OR, 5.58; 95 %CI, 3.11-10.0), and pre-existing recurrence (OR, 3.79; 95 %CI, 2.05-7.01) as independent factors were associated significantly with increased risk of malignancy.

CONCLUSION

Identification of the clinical factors responsible for increased risk of malignancy provides better insight in management planning for ameloblastoma.