AMELOBLASTOMA

Doloso, Shyra Jane B. DMD 2- CAD

Amelobalstoma

A benign, aggressive tumor that is invasive and persistent. Sometimes its called solid or multicystic ameloblastoma Adult most commonly affected Mandibular molar- ramus most commonly affected site Broad range age range: maen 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

Radiographically it appears osteolytic,typically found at tooth bearing areas of jaws and maybe either unilocular or multilocular. Margins are usually well defined and sclerotic. Clinical Features:
facial deformity difficulty moving your jaw loosening of your teeth swelling

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 bone-cutting.

Incision- cutting or surgical cut in the skin or flesh

Hemostasis- act of stopping blood from flowing

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 years old M Student Filipino

Complete Patient History Chief Complain Namamaga po ang aking baba My jaw is swelling

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 becomes bigger and bigger. 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 an 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

Tentative Diagnosis : Ameloblastoma

Differential Diagnosis. Odontogenic Keratocyst

AMELOBLASTOMA An ameloblastoma is a benign but locally agressivetumour arising from the mandible, or less commonly from the maxilla. Epidemiology Ameloblastomas are the second most common odontogenic tumor and account for up to a 3rd of such cases. They are slow growing and tend to present in the 3rd to 5th decades of life, with no gender predilection Pathology Ameloblastomas (not surprisingly) arise from ameloblasts, (part of the odontogenic epithelium, responsible for enamel production and eventual crown formation). Radiographic Features Well defined radiolucent area Rounded or scalloped margin

Some are unilocular but majority are multilocular

ODONTOGENIC KERATOCYST An odontogenickeratocyst (OKC) is a type of developmental cyst involving the mandible or maxilla. Epidemiology Odontogenickeratocysts typically present in younger patients (2nd 3rd decades), are often multiple, and may be seen in either the body or ramus of mandible (approximately 70% of all OKCs), or maxilla. 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

Typically rounded. Radiographic margins are usually well defined

and sclerotic. Multilocular radiolucencyScalloped margin.When loculations are large, the appearance is called as SOAP BUBBLE appearance

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.

ACANTHOMATOUS

Central area of follicles show extensive squamous metaplasia, often associated with keratin formation.Does not indicate a moreaggressive 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

BASAL CELL TYPE

Least common typeComposed 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.

o 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.

o 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

TREATMENT Hemimandibulectomy and Reconstruction of Mandible

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

Anesthetic Requirements Surgery Incision Hemostasis Occlusion setting with wiring Resection of the lesion Reconstruction of Mandile Placement of titanium plates with and without bone Graft Suturing GENERAL ANESTHESIA

After Surgery * Tubes,Drainage,Catheters and Other Medical Devices >A humidifier collar placed over your trach tube. It will provide moist air to your lungs > The intravenous (IV) line through which you will receive:

 Fluid. Antibiotics. Pain medication. Anticoagulants (to prevent your body from forming blood clots in the surgical area). >A Foley catheter to drain urine from your bladder. It is removed two or three days after surgery. >A feeding tube through your nose into your stomach. You will get high-protein liquid feedings and your medicines through this tube. You will not be able to eat and drink until the swelling from the surgery goes down. *Self Care *Oral Irrigation As soon as the rubber bands are removed, you will begin irrigating (wetting) your mouth with salt water and baking soda. This helps keep your mouth clean and moist. *Diet Most patients are discharged on a pureed diet. This means that foods have been put through a blender *Follow-up Appointments COMPLICATIONS Blood clot Speech and swallowing Bleeding Numbness Infection