Andrade Neelam N, Shetye Shweta P, Mhatre Tejas S
Department of Oral and Maxillofacial Surgery, Nair Hospital and Dental College, 107/1st Floor, A. L. Nair Road, Mumbai Central, Mumbai, 400 008 India.
J Maxillofac Oral Surg. 2013 Mar;12(1):60-7. doi: 10.1007/s12663-012-0387-1. Epub 2012 Jun 28.
The purpose of this study is to put forth our 15 year experience with pediatric ameloblastoma in the Indian population.
This retrospective study was carried out in the pediatric group of 18 years and below, presenting with and diagnosed for ameloblastoma, at our institution over the past 15 years. The required data was collected by reviewing patient's case notes, relevant radiographs, histopathological reports, and treatment charts. The incidence of pediatric ameloblastomas with respect to age, sex, site of occurrence, histopathologic type, the type of treatment instituted, and recurrence rate was noted.
Of the total 165 pediatric tumors, ameloblastoma was the most common, 29 cases (17.5%). It occurred commonly in the age group of 12-18 years (mean age 14 years) with a marked male predilection. The most common site of occurrence was the posterior mandible. Majority were of the unicystic type. Two ameloblastomas which appeared as unilocular radiolucency were diagnosed as solid type. Twenty-eight were benign and one was a rare malignancy (Ameloblastic carcinosarcoma). Only two recurrences were noted over 15 years, of which one tumor interestingly recurred as a peripheral variety which responded well to local excision. Ameloblastomas were either enucleated with mechanical curettage or resected followed by primary reconstruction with either a reconstruction plate or free fibula flap.
We conclude that ameloblastomas are not uncommon in Indian pediatric population. Unilocular, unicystic ameloblastomas in the pediatric age group can be treated conservatively owing to their growth potential. Emphasis must be given to a long-term regular follow-up, conserving a more radical approach in case of a recurrence. However, Unilocular appearing ameloblastomas may be of the solid type which needs to be borne in mind as it not only alters the treatment modality but also emphasizes the importance of pre-operative incisional biopsy. Solid and unicystic aggressive ameloblastomas must be treated radically. Primary reconstruction with the free fibula flap is a viable option.
本研究旨在阐述我们在印度人群中治疗儿童成釉细胞瘤的15年经验。
本回顾性研究针对过去15年内在我们机构就诊并被诊断为成釉细胞瘤的18岁及以下儿童群体。通过查阅患者病历、相关X光片、组织病理学报告和治疗记录收集所需数据。记录儿童成釉细胞瘤在年龄、性别、发病部位、组织病理学类型、所采用的治疗方式及复发率等方面的情况。
在总共165例儿童肿瘤中，成釉细胞瘤最为常见，共29例（17.5%）。其常见于12 - 18岁年龄组（平均年龄14岁），男性明显居多。最常见的发病部位是下颌骨后部。多数为单囊性类型。有两例表现为单房性透射区的成釉细胞瘤被诊断为实性型。28例为良性，1例为罕见的恶性肿瘤（成釉细胞癌肉瘤）。在15年期间仅记录到两例复发，其中1例肿瘤有趣的是复发为周边型，对局部切除反应良好。成釉细胞瘤要么通过机械刮除术摘除，要么切除后用重建钢板或游离腓骨瓣进行一期重建。
我们得出结论，成釉细胞瘤在印度儿童人群中并不罕见。儿童年龄组的单房性、单囊性成釉细胞瘤因其生长潜力可采用保守治疗。必须重视长期定期随访，复发时采用更激进的方法。然而，表现为单房性的成釉细胞瘤可能是实性型，这一点需要牢记，因为它不仅会改变治疗方式，还强调了术前切开活检的重要性。实性和单囊性侵袭性成釉细胞瘤必须进行根治性治疗。游离腓骨瓣一期重建是一种可行的选择。
