Lúcio P S C, Cavalcante R B, Maia R N, Santos E S, Godoy G P
Department of Dentistry, University Estadual da Paraíba, Campina Grande, Brazil.
Eur Arch Paediatr Dent. 2013 Jun;14(3):179-84. doi: 10.1007/s40368-013-0032-9. Epub 2013 Apr 30.
Ameloblastic fibro-odontomas (AFO) are rare lesions and defined by the World Health Organisation as a tumour composed of a proliferation of odontogenic epithelium immersed in ectomesenchyme reminiscent of the interdental papilla. It also presents inductive processes leading to formation of enamel and dentine, confusing, histopathologically, with odontoma. Despite numerous efforts, there is still considerable confusion over its controversial aetiopathogenesis and treatment. A brief review of the literature on the clinical, pathological and therapeutic features of this lesion is reported.
A case of aggressive AFO in a 3-year-old boy was referred to the Oral Diagnostics Service of Hospital General de Fortaleza for evaluation following a 3-months painless swelling in the right mandibular and facial regions. During anamnesis, the patient's carers reported no systemic problem and his medical history was non-contributory. Intra-orally there was a swelling of the right lateral portion of the mandible, adjacent teeth were not mobile and the oral mucosa appeared normal and showed no signs of ulceration. Radiographic examination, with panoramic radiography and cone beam computed tomography with three-dimensional (3D) reconstruction, was better able to identify the extent of bone involvement and showed an expansive hypodense image in the right mandibular region. 3D reconstruction showed expansion of buccal and lingual cortical bone and the preservation of basal bone.
Enucleation and curettage of the lesion were carried out and care was taken not to fracture the basal bone during the surgical procedure. Tissue specimens were sent for histopathologic analysis. Aspiration performed during surgery was negative for blood and other exudates.
FOLLOW-UP: No recurrence has occurred during a follow-up period of 11 months.
A comprehensive diagnosis including all clinical, radiographic and histopathologic features is necessary for the success of therapy, which varies from case to case, thus, improving the quality of life of patients with AFO.
成釉细胞纤维牙瘤（AFO）是一种罕见病变，世界卫生组织将其定义为由牙源性上皮增生并浸于类似牙间乳头的外胚间叶组织中构成的肿瘤。它还呈现出诱导形成釉质和牙本质的过程，在组织病理学上与牙瘤相混淆。尽管进行了大量研究，但关于其存在争议的病因发病机制和治疗仍存在相当大的困惑。本文报道了对该病变临床、病理及治疗特征相关文献的简要综述。
一名3岁男孩患有侵袭性AFO，因右下颌及面部无痛性肿胀3个月后被转诊至福塔雷萨综合医院口腔诊断科进行评估。在问诊过程中，患者家属报告无全身问题，其病史无参考价值。口腔内右下颌外侧部分肿胀，相邻牙齿未松动，口腔黏膜外观正常，无溃疡迹象。通过全景X线摄影和三维（3D）重建的锥形束计算机断层扫描进行影像学检查，能更好地确定骨受累范围，显示右下颌区域有一个膨胀性低密度影像。3D重建显示颊侧和舌侧皮质骨膨胀，基骨保留。
对病变进行了摘除和刮治，手术过程中注意避免基骨骨折。组织标本送去做组织病理学分析。手术中抽吸未发现血液及其他渗出物。
在11个月的随访期内未出现复发。
全面的诊断包括所有临床、影像学和组织病理学特征对于治疗成功是必要的，治疗方法因病例而异，从而提高AFO患者的生活质量。
