Ord R A, Blanchaert R H, Nikitakis N G, Sauk J J
Oral and Maxillofacial Surgery, Baltimore College of Dental Surgery, University of Maryland Medical Systems, Baltimore, MD, USA.
J Oral Maxillofac Surg. 2002 Jul;60(7):762-70; discussion, 770-1. doi: 10.1053/joms.2002.33242.
The purpose of this report was 1) to report the experience of the University of Maryland, Department of Oral and Maxillofacial Surgery (OMS Department) in the treatment of ameloblastoma in children and 2) to review the world literature on the treatment of ameloblastoma in children from 1970 to 2001.
This study first reviews the experience of the OMS Department of the University of Maryland with ameloblastomas in children and then reviews the literature on this subject. The first part of the study was undertaken by a retrospective chart review of all patients with a diagnosis of ameloblastoma in the OMS Department between May 1991 and December 1999. The literature on ameloblastoma in Western societies and Africa was separately reviewed from 1970 through 2001. Reports earlier than 1970 were not reviewed, as the histologic diagnosis of ameloblastoma was not well defined before that period.
In the Maryland series, 11 patients under the age of 20 years with ameloblastoma were treated. Eight patients were seen primarily, and 3 presented with recurrent lesions. The average age was 15.5 years; 5 of 11 patients were black, and 9 of 11 tumors were unicystic ameloblastomas. The literature review showed 85 children in the Western reports and 77 reported from Africa. The average ages were 14.3 and 14.7 years, respectively, but unicystic ameloblastomas accounted for 76.5% of the Western and only 19.5% of the African children, with an increased frequency of occurrence in the mandibular symphisis in African (44.2%) versus Western (5.8%) patients. Analysis of recurrence after enucleation of unicystic ameloblastomas in 20 children followed at least 5 years or until recurrence showed a recurrence of 40%.
Ameloblastomas in children differ from adults, with a higher percentage of unicystic tumors. African children appear to resemble the adult pattern. Although enucleation has been claimed to give acceptable recurrence rates in unicystic ameloblastoma, there are no large series with long follow-up in children. The histologic pattern that exhibits mural invasion in unicystic ameloblastoma suggests that more aggressive surgery is necessary.
本报告的目的是：1）报告马里兰大学口腔颌面外科（OMS科）治疗儿童成釉细胞瘤的经验；2）回顾1970年至2001年世界范围内关于儿童成釉细胞瘤治疗的文献。
本研究首先回顾了马里兰大学OMS科治疗儿童成釉细胞瘤的经验，然后回顾了关于该主题的文献。研究的第一部分是通过对1991年5月至1999年12月期间OMS科所有诊断为成釉细胞瘤的患者进行回顾性病历审查。分别回顾了1970年至2001年西方社会和非洲关于成釉细胞瘤的文献。早于1970年的报告未被审查，因为在此之前成釉细胞瘤的组织学诊断尚未明确。
在马里兰系列中，治疗了11例20岁以下的成釉细胞瘤患者。8例为初诊患者，3例为复发性病变。平均年龄为15.5岁；其中5例为黑人，11例肿瘤中有9例为单囊性成釉细胞瘤。文献综述显示，西方报告中有85例儿童，非洲报告中有77例。平均年龄分别为14.3岁和14.7岁，但单囊性成釉细胞瘤在西方儿童中占76.5%，在非洲儿童中仅占19.5%，非洲患者下颌骨联合部的发生率（44.2%）高于西方患者（5.8%）。对20例单囊性成釉细胞瘤摘除术后至少随访5年或直至复发的复发情况分析显示，复发率为40%。
儿童成釉细胞瘤与成人不同，单囊性肿瘤的比例更高。非洲儿童似乎与成人模式相似。虽然有人声称摘除术在单囊性成釉细胞瘤中可获得可接受的复发率，但在儿童中尚无大量长期随访的系列研究。单囊性成釉细胞瘤中表现为壁内浸润的组织学模式提示需要更积极的手术治疗。
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