Ameloblastoma

Definition
Ameloblastoma is a benign epithelial neoplasm that accounts for 10% of all odontogenic tumors.
These neoplasms originate from enamel-forming cells of the odontogenic epithelium which fail to
regress during embryonic development. Ameloblastoma is characterized by a slow growth pattern and
can grow to very large sizes and cause severe facial structural changes.
Ameloblastoma consists of 6 histological subtypes: follicular, plexiform, acanthomatous,
granulose cell, basal cell, and desmoplasic. These types can be combined and have nothing to do with
tumor prognosis. Ameloblastoma macroscopically consists of 3 types: solid or multicystic, unicast, and
peripheral. The multicystic or intra-osseous form is the most common type and has a significant clinical
aspect in ameloblastoma due to the appearance of focal invasion and can lead to recurrence and
metastatic.

Etiology
Ameloblastoma originates from enamel-forming cells of the odontogenic epithelial layer that fail
to regress during embryonal development, for example, residue from the dental lamina. If the
remaining dental lamina is outside the bone in the soft tissue of the gingiva or alveolar mucosa, it can
cause peripheral (peripheral) ameloblastoma. Some experts think that several factors that are
considered to be the cause of histodifferentiation disorders in ameloblastoma include (1) non-specific
irritant factors such as extraction, caries, trauma, infection, inflammation, and / or tooth eruption, (2)
malnutrition disorders, and (3) pathogenesis. viral.
According to Shafer 1974, the possible causes of ameloblastoma include (a) remains of enamel
organ cells, residual dental lamina or Hertwig's lining, residual epithelial molasses, (b) odontogenic
epithelium, especially dentigerus cysts, and odontomas, (c) developmental disorders. enamel organs,
(d) basal cells of the jaw surface epithelium, and (e) heterotopic epithelium in other parts of the body,
particularly in the pituitary gland. The claim that the cause of ameloblastoma originates from epithelial
odontogenic cysts, especially dentigerous cysts, is supported by Stanley and Diehl who reported
retrospectively 33% and 17% of all ameloblastomas arising in or in association with dentigerous cysts.

Pathomechanism
These tumors develop slowly, so they can show swelling. Most of the patients generally present
with swelling and asymmetry of the face. Pain has been reported because it is associated with
secondary infection. Patients also rarely complain of headaches. Other effects include tooth movement
and displacement, tooth root resorption, paraesthesia (tingling) when the inferior alveolar canal is
involved, failure of tooth eruption, and very rarely ameloblastoma may develop mucosal lesions
(ulceration).

Clinical Manifestations
 Clinically ameloblastoma is usually asymptomatic and does not cause changes in sensory nerve
function. Sometimes a small tumor can be identified on routine radiographs. As the tumor enlarges, it
forms a firm swelling and can then cause a thinning of the cortex resulting in egg shell crackling. The
slow growth also allows reactive bone formation which leads to massive enlargement and distortion of
the jaw. If these tumors are neglected, they can lead to bone perforation and spread to the soft tissues,
making excision difficult. In general, ameloblastoma is benign but locally invasive, whereas maxillary
ameloblastoma appears as a more aggressive and persistent lesion. Whereas in patients with primary
sinonasal ameloblastoma, a study showed mass lesions and nasal obstruction, sinusitis, epistaxis, facial
swelling, dizziness, and headache.