Ameloblastoma is defined as unicentric, non-functional, intermittent in growth, and anatomically benign tumour that is clinically persistent
Management of Ameloblastoma
Aim
a. Complete eradication of the lesion.
b. Reconstruction of resultant defect.
Successful treatment is the treatment that renders an acceptable prognosis and causes minimum disfigurement. Curettage
i) Least desirable line of treatment as it has high recurrence chances.
ii) The characteristic feature of the tumour is that it microscopically infiltrates bone beyond the tumour. Bone interface is seen in imaging.
iii) A safe margin of involved bone is opposite 2 cm for solid multicystic lesions. For Intraosseous Solid/multicystic Ameloblastoma
1. En bloc resection or marginal resection without continuity defect.
2. Segmental resection with continuity defect.
Aggressive Reconstruction in Maxilla
1. Tumour confined to maxilla without orbital floor involvement—partial maxillectomy.
2. Tumour involving orbital floor, but not the periorbital area—total maxillectomy.
3. Tumour involving orbital content—total maxillectomy with orbital exenteration.
4. Tumour involving skull bone—Skull base resection plus neurosurgical procedure.
Multiple Ameloblastoma
i) Recurrence rate up to 50% during first five years.
ii) Long-term follow-up is a must.
Unicystic ameloblastoma.
Unicystic Ameloblastoma
i) Unicystic ameloblastoma is a separate entity from conventional ameloblastoma.
ii) Accounts for about 10–15% of intraosseous ameloblastoma.
Clinical Feature
a. Seen most commonly in younger aged patients.
b. 90% cases seen in mandibular posterior region.
c. Lesion is often asymptomatic.
Radiographic Features
a. Well circumscribed painless swelling of jaw.
b. Radiolucent area that surrounds the crown of an unerupted mandibular third molar.
Histopathology
Three distant types can be seen:
1. Luminal unicystic ameloblastoma: It occurs on the luminal surface of a cyst. Base of tumour is made up of cystic epithelium backed by connective tissue.
a. Basal layer of columnar or cuboidal cell exhibiting reverse polarization of nuclei.
b. Overlying cells are loosely arranged resembling stellate reticulum.
2. Intraluminal unicystic ameloblastoma:
It produces several nodular growth which projects from cysts lining into the cyst lumen.
3. Mural type: Neoplastic cells infiltrates into connective tissue wall of cyst capsule.
Treatment
a. Enucleation and curettage.
b. Recurrence rate is low compared to CA.
Treatment modalities of ameloblastoma.
Management of Ameloblastoma Aim
a. Complete eradication of the lesion.
b. Reconstruction of resultant defect.
Successful treatment is the treatment that renders an acceptable prognosis and causes minimum disfigurement.
Curettage
i) Least desirable line of treatment, as it has high recurrence chances.
ii) The characteristic feature of the tumour is that, it microscopically infiltrates bone beyond the tumour. Bone interface is seen in imaging.
iii) A safe margin of involved bone is opposite 2 cm for solid multicystic lesions.
For Intraosseous Solid/multicystic Ameloblastoma
1. En bloc resection or marginal resection without continuity defect.
2. Segmental resection with continuity defect. Aggressive Reconstruction in Maxillla
1. Tumour confined to maxilla without orbital floor involvement—partial maxillectomy.
2. Tumour involving orbital floor, but not the periorbital area—total maxillectomy.
3. Tumour involving orbital content—total maxillectomy with orbital exenteration.
4. Tumour involving skull bone—Skull base resection plus neurosurgical procedure.
Multiple Ameloblastoma
i) Recurrence rate up to 50% during first five years.
ii) Long-term follow-up is a must.
