Intraosseous ameloblastoma

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Demographic data

Ameloblastoma occurs over a broad age range; cases have been reported in children younger than 10 years through elderly adults older than 90 [1]. The average age at diagnosis consistently is reported in the age range of 33 to 39, and most cases cluster between ages 20 and 60 years [1], [2], [3], [6], [7]. Only about 10% of cases are reported to arise in children, and less than one third of those occur in children younger than 10 years [8]. No significant sex predilection has been reported [1],

Origin

The origin of ameloblastoma is not known with certainty, but in concert with concepts of neoplasia in general, it is likely the result of alterations or mutations in the genetic material of cells that embryologically are preprogrammed for tooth development. Environmental factors and individual patient variables (eg, general health status, nutritional status) also likely have a role in modulating the incidence of the disease [1], [3]. This theory is demonstrated by the finding that the average

Site of occurrence

Ameloblastoma occurs in all areas of the jaws, but the mandible is the most commonly affected area (more than 80% of all cases occurring there) [1], [2], [3], [6]. Within the mandible, the molar-angle-ramus area is involved three times more commonly than are the premolar and anterior regions combined [2], [3]. Statistics on the location of maxillary ameloblastomas are more variable and more difficult to interpret. Some studies report a low incidence in the anterior maxilla [9], [10], [11],

Clinical presentation

Patients with ameloblastoma most commonly present with chief complaints of swelling and facial asymmetry [1], [2], [3], [8], [11], [13]. Although the swelling is typically asymptomatic, pain is an occasional presenting sign [2], [3], [9]. A chief complaint of painless swelling often heralds a lesion of long duration and significant size [1], [3]. The average reported size of ameloblastomas in the largest study to date was 4.3 cm [1]. Continued growth of the tumor and enlargement of the involved

Radiographic presentation

Radiographically, the intraosseous ameloblastoma classically is described in dental periapical and panoramic films as a multilocular or “soap-bubble” radiolucency [2], [14]. The increasingly routine use of CT studies in evaluating the clinical extent of lesions has resulted, however, in accumulating evidence that truly multilocular ameloblastomas are not encountered often. When visualized in CT images, lesions that appear multilocular on plane films usually show scalloping resorption of the

Histopathology

Six histopathologic subtypes of ameloblastoma are recognized: follicular, acanthomatous, granular cell, basal cell, desmoplastic, and plexiform [1], [2], [3], [9], [16], [19]. Most tumors show a predominance of one pattern, but few lesions are found to be composed purely of one histopathologic subtype [2], [3]. Mixtures of the different patterns commonly are observed. Lesions tend to be subclassified according to the predominant pattern that is present. The various subtypes have been studied

Growth patterns and treatment implications

Although the importance of the specific histologic subtype of ameloblastoma in the determination of biologic behavior is open to debate, it is well documented that the overall growth pattern of the neoplasm is important [1], [3], [10], [12], [20]. It has significant implications in treatment decisions and the incidence of recurrence [12]. The growth pattern of intraosseous ameloblastoma can be classified into two broad categories: (1) conventional ameloblastoma and (2) unicystic ameloblastoma

Summary

Ameloblastoma is the most significant odontogenic neoplasm of concern for oral and maxillofacial surgeons. It shows a wide variety of clinical and radiographic presentations and can be encountered in any area of the jaws. Six histopathologic subtypes are recognized, and the specific histopathologic features of each are detailed and discussed. Although the histopathologic pattern may have implications for the likelihood of recurrence, it should not affect treatment decisions. The growth pattern

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