Department of Oral and Maxillofacial Surgery, Government Dental College, Medical College Campus, Thiruvananthapuram, Kerala, India.
J Craniofac Surg. 2024;35(1):158-162. doi: 10.1097/SCS.0000000000009706. Epub 2023 Sep 8.
Ameloblastoma is a benign neoplasm composed of epithelial tissue with invasive and infiltrative behavior at the local level and a high recurrence rate, with various histopathologic patterns and clinical forms. Approximately 85% of conventional ameloblastomas occur in the mandible, most often in the body, angle, and ascending ramus area. The treatment modalities include both conservative and radical treatments. Postoperative follow-up is most important in the treatment of ameloblastoma.
To describe the clinicopathologic profile of mandibular ameloblastoma in patients undergoing different surgical modalities. The primary objective was to describe the clinicopathologic profile and surgical management of mandibular ameloblastoma in patients aged ≥18 years, who had reported to a tertiary dental care center for follow-up during the study period. The secondary objective was to describe the distribution of comorbidities associated with different surgical modalities and reconstructive methods.
A total of 34 patients with mandibular ameloblastoma who underwent various surgical modalities between 2011 and 2021 were studied. Information was collected using a predesigned proforma and statistically analyzed.
Thirty-four review cases of ameloblastoma were included in the study. The patients were analyzed concerning age, sex, site, size, clinical presentation, radiographic pattern, histopathologic subtype, type of surgery, and associated comorbidities. Most cases of mandibular ameloblastoma involve the age of 16 to 55 years. The mean age of occurrence was found to be 35.5±13.2. A female preponderance, a tumor size range of 2 to 4 cm, a multicystic variant, involvement of the mandibular body in the premolar-molar area, root resorption, cortical perforation, and a follicular type of histopathologic pattern were the common presentations. Isolated anterior tumors restricted to the incisor/canine region were not found. The common surgical modalities undertaken were conservative methods such as enucleation, and chemical cauterization, and radical methods such as marginal mandibulectomy and segmental resection. Reconstruction using a titanium plate or free fibular graft was performed in the indicated cases. The common comorbidities included difficulty in chewing and loss of facial contour. Recurrence after surgical treatment was rare. Only 9% of cases developed a recurrence within 5 years. No recurrence was noted in cases treated with radical treatment, whereas 50% of cases treated with conservative methods showed recurrence.
The age of occurrence, site, and size of the tumor, cortical perforation, root resorption, histopathologic type, and radiographic patterns are widely considered factors in devising a treatment plan for mandibular ameloblastoma. However, there may be rare instances where these tumors behave differently regardless of their innocuous clinicopathologic presentation. Surgical procedures such as segmental resection and marginal mandibulectomy were found to be promising for the eradication of the tumor, and prevention of recurrences and metastasis. However, conservative measures such as enucleation and chemical cauterization were fraught with an increased risk of tumor recurrence and metastasis. Future studies with a larger sample size should focus on the clinicopathologic characteristics of ameloblastoma to elucidate its varied behavior and develop newer and advanced treatment modalities that would provide better surgical and postsurgical outcomes in affected patients.
成釉细胞瘤是一种由上皮组织组成的良性肿瘤，具有局部侵袭性和浸润性行为，且复发率较高，具有多种组织病理学模式和临床形式。约 85%的传统成釉细胞瘤发生在下颌骨，最常见于体部、角部和升支区域。治疗方法包括保守治疗和根治性治疗。成釉细胞瘤治疗中最重要的是术后随访。
描述不同手术方式治疗下颌骨成釉细胞瘤的临床病理特征。主要目的是描述在研究期间到三级牙科保健中心接受随访的年龄≥18 岁的患者的下颌骨成釉细胞瘤的临床病理特征和手术管理。次要目的是描述与不同手术方式和重建方法相关的合并症的分布。
研究了 2011 年至 2021 年间接受各种手术方式治疗的 34 例下颌骨成釉细胞瘤患者。使用预先设计的表格收集信息，并进行统计学分析。
本研究共纳入 34 例成釉细胞瘤回顾性病例。对患者的年龄、性别、部位、大小、临床表现、影像学模式、组织病理学亚型、手术类型和相关合并症进行了分析。大多数下颌骨成釉细胞瘤发生在 16 至 55 岁。发病平均年龄为 35.5±13.2 岁。女性多见，肿瘤大小为 2 至 4cm，多房性变异，下颌体累及前磨牙-磨牙区，有牙根吸收、骨皮质穿孔和滤泡型组织病理学模式。未发现仅局限于切牙/犬齿区域的孤立前牙肿瘤。常见的手术方式包括保守方法，如剜除和化学烧灼，以及根治性方法，如边缘下颌骨切除术和节段切除术。在指征明确的情况下，使用钛板或游离腓骨移植进行重建。常见的合并症包括咀嚼困难和面型轮廓丧失。手术治疗后复发罕见。仅 9%的病例在 5 年内复发。根治性治疗后无复发，而保守治疗后 50%的病例复发。
发病年龄、部位和肿瘤大小、骨皮质穿孔、牙根吸收、组织病理学类型和影像学模式被广泛认为是制定下颌骨成釉细胞瘤治疗方案的因素。然而，即使临床表现良性，肿瘤也可能有罕见的不同行为。节段切除术和边缘下颌骨切除术等手术方法被认为是根除肿瘤、预防复发和转移的有前途的方法。然而，剜除和化学烧灼等保守方法存在肿瘤复发和转移的风险增加。未来的研究应关注成釉细胞瘤的临床病理特征，以阐明其不同的行为，并开发新的和先进的治疗方法，为受影响的患者提供更好的手术和术后结果。
