Conservative surgical treatment for ameloblastoma: a report of three cases

Hemimaxillectomy defect reconstruction with a maxillary obturator prosthesis using a 3D-model stereolithography: A case report

INTRODUCTION

Complete or partial resection of the maxilla during tumor surgery causes oronasal defects, leading to oral-maxillofacial dysfunction, for which the obturator prosthesis is an important treatment option. Traditional manufacturing of obturators involves great complexity, often results in impaired function and fit, and is time-consuming. This paper presents a case of using 3D stereolithography as a guide design for defect reconstruction with a maxillary obturator prosthesis.

CASE PRESENTATION

We report a 14-year-old girl who presented with facial deformities followed by swelling and pain that reached the orbit floor on the left side of her face. A non-contrast head magnetic resonance imaging scan showed a mass in the left maxilla that extended from the buccal mandible to the left side of the oral cavity. An incisional biopsy indicated that the mass was an ameloblastic fibroma. The entire tumor was treated with a hemi-maxillectomy and reconstruction using an obturator. No further complaints or recurrence signs were evident after six months.

DISCUSSION

Treatment options for ameloblastoma include enucleation and excision. Due to the severity of the lesion in our case, the entire maxilla had to be removed with the tumor, using a hemimaxillectomy with the assistance of a 3D-printed model, and an obturator was used for reconstruction.

CONCLUSION

Ameloblastoma is a tumor with a high risk of recurrence. This case underwent a complete hemi-maxillectomy with simultaneous repair using a 3D-printed obturator, with satisfactory functional and cosmetic outcomes.

Conservative Management of Unicystic Ameloblastoma of Mandible Evolving from Dentigerous Cyst in a Paediatric Patient: A Case Report

Massive cystic lesions involving a mandible always present a diagnostic and treatment challenge. Unicystic ameloblastoma (UA) is a variant of ameloblastoma encompassing about 6% of ameloblastomas. They represent cystic lesions that reveal clinical and radiographic features of a cyst, but the histopathological features demonstrate a typical ameloblastomatous epithelium lining the cyst. It is a variant of ameloblastoma, usually having clinical and radiographic similarities with dentigerous cysts, hence posing preoperative diagnostic difficulties. Adult treatment protocol cannot be applied to the pediatric population since resection may cause an alteration in craniofacial development leading to functional and esthetical damage, which can directly affect their quality of life. A more conservative approach of enucleating the lesion seems to be a promising treatment modality of UA in the pediatric age group. We present a case of mural variant of UA arising from dentigerous cyst in an 8-year-old male patient.

Conventional Ameloblastoma. A Case Report with Microarray and Bioinformatic Analysis

Ameloblastoma is a rare benign epithelial odontogenic neoplasm, but with great clinical implications, as despite its benignity and slow growth, most cases are locally aggressive with a significant recurrence rate. Histological, cellular, or molecular analyses of its pathogenesis have confirmed the complexity of this neoplasm. We present the case of a 20-year-old patient with a suggestive clinical and radiographic diagnosis of ameloblastoma. An incisional biopsy was obtained confirming the diagnosis of conventional ameloblastoma. Left hemimandibulectomy and plate reconstruction were performed. Histopathological analysis of the surgical specimen confirmed the conventional ameloblastoma with a plexiform pattern and significant areas of cystic degeneration and amyloid-like-like deposits. Additionally, a microarray was carried out with bioinformatic analysis for the enrichment, protein interaction, and determination of eight hub genes (CRP, BCHE, APP, AKT1, AGT, ACTC1, ADAM10, and APOA2) related to their pathogenesis.

Recurrent Ameloblastoma: Long Term Outcomes with Free Fibular Bone Graft

Ameloblastoma is a locally aggressive benign neoplasm of jaw that has high propensity to recur. Pathological subtype and intent of surgical excision during primary surgery are two factors that are known to affect the prognosis in these cases. Nevertheless, there are hardly any studies which have studied recurrent ameloblastoma cases. Apart from sharing a tertiary care cancer center's experience in managing a series of recurrent ameloblastoma cases, we discuss some of the recent literature related to pathophysiology and principles related to their surgical management. Retrospective chart review of all those recurrent ameloblastoma cases which were operated between October 2013 and January 2016 and were subsequently followed up for minimum of 3 years. Total of 9 recurrent ameloblastoma cases were operated in the study period. All our patients had less-radical or non-curative intent surgical treatment in the past, and current treatment consisted wide excision of the involved segment of mandible with free fibular reconstruction. Among the 6 patients who were followed up for more than 3 years, none developed recurrence at 56.5 months of mean follow up duration. Almost all these patients had optimal results with good quality of life in terms of oral speech intellectuality and cosmetic perception of self. Complete excision of the involved segment of bone with reconstruction using the composite free fibular graft can provide optimal functional outcomes and can significantly lessen the chances of further recurrences.

Potential role of active decompression and distraction sugosteogenesis for the management of ameloblastomas: Report of two cases and review of the literature

Ameloblastomas are aggressive odontogenic entities well-known for their high tendency to recur. Clinical presentation includes lesions discovered on routine examination or radiographs, pathologies causing facial swelling, pain, cortical expansion, tooth mobility, root resorption, and paresthesia. Radiographic findings comprise large unilocular or multilocular radiolucencies with well-defined borders associated to an impacted tooth. Ameloblastomas are classified as unicystic, multicystic/solid, and peripheral. Treatment options include marsupialization, decompression, enucleation, or curettage with or without adjuvant measures such as Carnoy's solution, marginal resection, and segmental resection. Recently, active decompression with distraction sugosteogenesis (ADDS) was introduced for the conservative management of odontogenic cystic conditions. The purpose of this paper is to present 2 cases of a conventional ameloblastoma treated by means of ADDS. The purpose of this novel approach is to significantly reduce the amount of time required to decompress cystic-like lesions. In these cases, ADDS proved to be a viable treatment because it demonstrated a reduction in size of the initial lesion by new osseous formation within 2 weeks of placement of the device. The cases presented in this paper demonstrate that ADDS could be a valuable treatment modality for this type of ameloblastoma, although further research is necessary to validate this philosophy.

Histopathologic Feature of Hyalinization Predicts Recurrence of Conventional/Solid Multicystic Ameloblastomas

The histologic properties of tumors seem to affect their biological behavior, and the same holds good for solid multicystic ameloblastoma (SMA), a benign, locally destructive lesion. Hyalinization is one such histological factor that has been demonstrated to correlate with the biological behavior of neoplasms. The present study aimed to analyze the correlation between the severity of hyalinization (SOH) and the recurrence potential of SMAs. The study was performed on formalin-fixed, paraffin-embedded (FFPE) diagnosed archival cases of SMA, follicular SMA (n = 35) and plexiform SMA (n = 25). The cases were evaluated for SOH and scored from 0–3, and the correlation between SOH and recurrence was analyzed for statistical significance. The clinical parameters of the lesion were analyzed for statistical correlation with recurrence. The SOH significantly correlated with the recurrence of SMA (p = 0.001). The histologic type did not influence the biological behavior of SMA. The location of SMA in the body of the mandible (p = 0.036), multilocular radiolucency (p = 0.001) and root resorption (p = 0.002) also showed strong statistical correlation with recurrence. It is evident from the present study that hyalinization strongly correlates with the biological behavior of SMA. Future studies with advanced investigations could validate the presence of hyalinization and identify the origin of the hyalinized product in SMAs.