Management Of Ameloblastoma Research Articles

Prognostic significance of MCM2high/Ki-67high in ameloblastoma

ObjectiveMinichromosome maintenance (MCM) protein 2 is critical for the beginning of DNA replication and is a notable marker for proliferating cells. The prognosis and management of ameloblastoma are based on histology and other factors. However, immunohistologic markers capable of detecting recurrence-prone ameloblastoma with a poor prognosis have not been adequately investigated. This study aimed to identify the association between MCM2 overexpression and recurrence prognosis and risk stratification. MethodsThirty-two patients who had been diagnosed with ameloblastoma at our department between January 1982 and December 2019 were included in this study. Thirty-two (fifteen follicular, ten plexiform, five unicystic, two desmoplastic) subtype cases were analyzed for immunohistochemical expressions of MCM2 and Ki-67. ResultsDisease-free survival (DFS) analysis revealed that patients with MCM2high/Ki-67high ameloblastoma had a significantly shorter median survival time (63 vs. 360 months) and lower DFS survival rate (50.0% vs. 90.0%) than those with MCM2low/Ki-67low (p = 0.003). Multivariate analysis revealed that a location (maxillary primary ameloblastoma) and MCM2high/Ki-67high were independent risk factors for DFS. ConclusionOur results identified MCM2high/Ki-67high ameloblastoma as a subgroup with poor recurrent prognosis and DFS. Ameloblastoma should be assessed using immunohistochemical staining. Our study revealed that tumors with a worse recurrent prognosis require appropriate clinical surveillance.

Review on Principles and Etiopathogenesis of Ameloblastoma

Ameloblastoma, a rare odontogenic tumor that has fascinated clinicians and researchers for decades. This review delves into the tumor's origin, deeply investigating the etiopathogenesis rooted in the odontogenic epithelium associated with enamel formation. It elucidates key cellular and molecular mechanisms driving its development, shedding light on the intricate factors governing initiation and progression. Furthermore, the review focuses on the management of ameloblastoma, with an emphasis on surgical interventions. This review also addresses the vexing issue of tumor recurrence and the potential complications that can arise during and after treatment. By examining these issues in detail, it offers essential insights into effective strategies for managing these aspects of ameloblastoma, ensuring that clinicians and researchers are well-equipped to navigate the complexities of this unique odontogenic tumor. In summary, this review offers a holistic and in-depth exploration of ameloblastoma, from its origins to its management and the challenges it presents to the medical community.

The Role of BRAF Inhibitors in the Management of Ameloblastoma: A Literature Review.

Ameloblastoma is one of the most prevalent but enigmatic benign odontogenic tumors of the jaw, accounting for approximately 10% of all maxillary and mandibular tumors. This neoplasia is distinguished by exhibiting several clinical and histological variants along with several mutations that affect its behavior. The ameloblastoma treatment plan is determined by the tumor's size, anatomical location, histologic variant, and anatomical involvement. On chromosome 7, there is a proto-oncogene called BRAF. When BRAF is mutated, it becomes an oncogene and continuously produces proteins like MEK and ERK, members of mitogen-activated protein kinase (MAPK). In the signaling pathway, these proteins activate transcription factor inside the nucleus that helps in cell division and growth. Numerous neoplasms have been linked to more than 40 BRAF mutations. The most common one is BRAF proto-oncogene serine/threonine kinase (BRAF) V600E, whose treatment has been linked to a positive outcome. BRAF inhibitors like vemurafenib, dabrafenib, and sorafenib have shown excellent results, especially in metastatic ameloblastoma. BRAF, particularly in the case of metastatic ameloblastoma, inhibitors such as vemurafenib, dabrafenib, and sorafenib, has demonstrated outstanding results. Targeted therapies have been employed as adjuvant therapies to enhance cosmetic outcomes, even though no reports of serial cases demonstrate their effectiveness in ameloblastomas. In the treatment of ameloblastomas, the identification of BRAF V600E and additional mutations as the prime targeted therapies has proven to be a significant breakthrough where surgical treatment was contraindicated. In this article, we review the presence of BRAF V600E mutations, their inhibitors, and targeted therapies in ameloblastoma.

Characteristic and Management of Ameloblastoma In Oral And Maxillofacial Surgery At Hasan Sadikin General Hospital: Retrospective Study

Introduction Ameloblastoma is common benign epithelial tumor of odontogenic origin. The presentation of ameloblastoma is unique as it locally aggressive tumor with high recurrence rate if not treated adequately. This study aimed to conduct retrospective study to analyze the characteristics and management of ameloblastoma in patient Oral and Maxillofacial Surgery at Hasan Sadikin General Hospital between periods of January 2020 – December 2020. Material and Method This was a retrospective, descriptive feature of all histopathologically diagnosed ameloblastoma during 2020. We took data from each patient such as demographic (gender, age), radiological features, histopatholoical diagnosis, location, management, defect and reconstruction of ameloblastoma. Result A total 23 patients were diagnosed with conventional ameloblastoma, including 11 plexiform (48%), ten follicular (43%), and two mixed types of plexiform-follicular (9%). Among them, 6 (21%) patients were treated conservatively (Enucleation and dredging) and 17 patients were treated radically with segmental resection in 9 (39%) patients, hemimandibulectomy in 5 (22%) patients, marginal resection in 2 (9%) patients, and hemimaxillectomy in one (4%) patient. Conclusion The common characteristic of ameloblastoma is follicular and plexiform ameloblastoma with the most predilection location in mandible region and the peak of incidence in third decades of life. Radical treatment is more often used to reduce recurrence rates, whereas conservative measures are normally preserved in children and adolescent. Keywords: Ameloblastoma, Epidemiology, Odontogenic, Tumour

Effect of radiographic & histopathologic variants in management of ameloblastoma

Introduction: Ameloblastoma is a rare, benign odontogenic tumor that accounts for 1% of all tumors of the jaws. We aim to compare the ameloblastoma recurrence rate according to the type of treatment: radical or conservative and as per the radiographic, histologic features. Material and methods: we conducted a retrospective study and collected the data based on the radiological, and histological and the type of treatment: conservative or radical and to compare the recurrence rate according to the type of treatment. Results: Thirty Patients were included, managed by conservative treatment (CT) in 26 cases and radical treatment (RT) in 14 cases. The recurrence rate was 90.9% in the CT group and 9.1% in the RT group (P = 0.025) with a mean follow-up of 56.2 months. Conclusion: The recurrence rate after conservative treatment was higher than that after radical treatment. The choice of treatment must be adapted to the macroscopic and histological characteristics of each tumor and to the patient.

Mechanism and Potential Therapy in Ameloblastoma: Akt Signaling Pathway

BACKGROUND: Ameloblastoma is the most common benign aggressive tumor. They are more prevalent in the mandible than in the maxilla, mostly observed on the posterior of the jaw. Ameloblastoma can arise at any age, however it most usually affect patients between the ages of 20 and 40. Numerous efforts have been made to develop molecular targeted therapies to treat cancers, such as Akt inhibitors. However, these drugs have not been tested for treating ameloblastoma yet, since underlying molecular factors have yet to be identified. This study was carried out to delineate possible molecular mechanisms related to the Akt signaling pathway in ameloblastoma and potential drugs for ameloblastoma treatment. CONTENT: Akt signaling pathway in ameloblastoma has been implicated in the formation and progression of tumors. Akt signaling is involved in various cellular mechanisms, such as cell cycle, apoptosis, and cytoskeletal rearrangement, which includes Phosphatidyl Inositol 3 Kinase (PI3K)-Akt signaling, Akt-Nuclear Factor (NF)-κB signaling, Akt-Mammalian Target of Rapamycin (mTOR) signaling, Akt-B-cell Lymphoma (Bcl)-2 Family signaling, Akt-Survivin signaling. Potential ways of treatments using chemical compounds and micro RNA (miRNA), and Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) were explored as well.SUMMARY: The present review highlights various Akt signaling involved in ameloblastoma and its potential pathways for treatments, while the gold standard of ameloblastoma treatment is still surgery to remove the tumor, there are many potential agents through various means of inhibition for ameloblastoma. Therefore, understanding the underlying signaling on ameloblastoma is necessary to induce inhibition on ameloblastoma. More research in potential ways to inhibit Akt signaling in ameloblastoma will lead to a better management of ameloblastoma in the future. KEYWORDS: ameloblastoma, Akt, PI3K, NFkB, mTOR, Bcl-2, miRNA, CRISPR

Ameloblastoma: Pathogenesis, Clinical and Radiological Features, Classification, and Management

Background: Ameloblastoma are benign epithelial odontogenic tumors affecting the jaws. Objective: The main objective of this article is to review the pathogenesis, clinical and radiological features, classification, and management of ameloblastoma. Methods: A literature review mainly of the Pubmed database was done using the keywords: “ameloblastoma pathogenesis”; “ameloblastoma classification”; “ameloblastoma history”; “clinical and radiological features of ameloblastoma”; and “management of ameloblastoma”. Results: In 2017, ameloblastomas were classified by W.H.O into three categories: a) unicystic, b) conventional, and c) extraosseous/peripheral. Clinically, they are slow-growing, localized, aggressive neoplasms. Radologically, they mainly present as extensive, radiolucent, multilocular images, with a typical “soap bubble-like” appearance with a thinner, expanded, and eroded cortical plate. The linked non-erupted tooth is displaced and the roots of the adjacent teeth undergo clear resorption. Conclusion: Because of their late signs and symptoms, ameloblastomas are usually identified at an advanced stage. Their management typically includes a large resection with safety margins and immediate reconstruction when possible. Regular long-term postoperative follow-ups are mandatory for optimum treatment outcome and recurrence prevention.

The epidemiology and management of ameloblastomas: A European multicenter study

The present study aimed at assessing the epidemiology including demographic variables, diagnostic features, and management of ameloblastomas at several European departments of maxillofacial and oral surgery.The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, site, size, radiographic features, type, histopathological features, kind of treatment, length of hospital stay, complications, recurrence, management and complications of the recurrence.A total of 244 patients, 134 males and 110 females with ameloblastomas were included in the study. Mean age was 47.4 years. In all, 81% of lesions were found in the mandible, whereas 19% were found in the maxilla. Mean size of included ameloblastomas was 38.9 mm. The most frequently performed treatment option was enucleation plus curettage/peripheral ostectomy in 94 ameloblastomas, followed by segmental resection (60 patients), simple enucleation (46 patients), and marginal resection (40 patients). A recurrence (with a mean follow up of 5 years) was observed in 47 cases out of 244 ameloblastomas (19.3%). Segmental resection was associated with a low risk of recurrence (p = 0003), whereas enucleation plus curettage/peripheral ostectomy was associated with a high risk of recurrence (p = 0002). A multilocular radiographic appearance was associated with a high risk of recurrence (p < .05), as well as the benign solid/multicystic histologic type (p < .05).Within the limitations of the study it seems that the management of ameloblastomas will probably remain controversial even in the future. Balancing low surgical morbidity with a low recurrence rate is a difficult aim to reach.

Management of Ameloblastoma with Different Imaging Modalities

Management of Ameloblastoma with Different Imaging Modalities

The Profile of Ameloblastoma and the Status of Routine Clinical Records from a Developing Country Context

Ameloblastoma is a common odontogenic tumor with the potential of local invasion and recurrences. Moreover, it has a variable presentation and many challenges surrounding the management of the condition [1]. From public health perspectives through to molecular aetiopathogenesis it paints the portrait of heterogeneity and complexity [2-4]. For example, gender and age distribution, presenting complaints, the clinical record keeping scenarios in developing countries compared to the developed countries, the aggressive potential for local invasion, possibility for malignant transformation etc. Moreover, choosing the optimal mode of management (radical vs conservative surgery) poses a dilemma to the clinician. Findings of retrospective studies on de-identified case notes retrieved for varying follow-up periods provides the major source of scientific evidence on management of ameloblastoma.

Management of Ameloblastoma with Free Tissue Flap in Comparison with Other Reconstructive Options Available.

To review the management and reconstruction of ameloblastoma of mandible in different age groups over a period of 11years. This retrospective study includes 51 cases operated in the Maxillofacial Unit, Bhagwan Mahaveer Jain Hospital, Bangalore, from the year 2007 to 2017. The data of these patients were collected to record demographic data such as age, gender with site of tumour and type of reconstruction after resection, follow-up period and incidence of complications. This study evaluated the outcome in terms of aesthetics, function and choice of reconstruction in different age groups. Most patients were of 21-40 age group. 37 (72.5%) were found to be unicystic ameloblastoma. 41 (80.3%) patients underwent reconstruction following the resection. There was a change in trend seen over a period of time with free grafts and reconstruction plate being historical, except in special situations like old age and unfit patients. According to one-way ANOVA and Tukey's post hoc analysis, free flaps were known to take a longer duration (mean = 503min) compared to other modes of reconstruction. However, free grafts and free flaps were demonstrated to have a good facial contour and speech with most cases dentally rehabilitated with implants. Among the complications, 1 (16%) case with reconstruction plate showed screw loosening, 2 (28%) cases with free grafts showed graft exposure, and 1 (3.5%) case with free flap had venous congestion, making free flaps the most reliable option. Free fibula is the gold standard of mandible reconstruction, but depending on age, medical condition, economic status and size of the defect other modes of reconstruction can be chosen with the acceptance of suboptimal results.

Extensive ameloblastoma in young patient: 5-year follow-up with no recurrence using conservative treatment

ABSTRACT Ameloblastoma is a benign, odontogenic tumor that, due to its low rate of incidence, slow growth and local invasiveness, can be treated with a variety of surgical approaches, ranging from conservative to radical procedures. The conventional variant of ameloblastoma, though, is more aggressive and common, presenting a higher rate of recurrence than the unicystic and extraosseous/peripheral types; usually, the treatment of choice for this variant employs more invasive procedures. This report is of a 13-year-old male patient who presented with a swelling on the posterior mandibular region, on the left side of his face. Intraoral examination revealed lingual displacement of teeth 36 and 37. The clinical, radiographic and histopathological analyses confirmed the diagnosis of ameloblastoma (plexiform histological type). The patient was treated with curettage and peripheral osteotomy and a 5-year follow-up examination showed the area to have healed completely, with no evidence of recurrence. Consequently, although the clinical management of ameloblastoma is often based on invasive surgical approaches, large tumors treated with conservative surgery are less aesthetically and functionally impaired, and may demonstrate good prognosis with no recurrence in the 5-year follow-up period, as in the case reported here.

Management of ameloblastoma and its consequences

The study considered clinical prospective observation of 113 patients suffered from different variety of ameloblastoma. Among them, 75% female were more often effected. Half (58.8%) of the patient was treated by dredging, 27.1% dredging with carnoy’s solution, and 33.9% by disarticulation with hemimandibulectomy using reconstruction plate. For the first five years, participants were recalled at every 3, 6 and 12 months, and then after every 2 years. 70% patients were drop out within 2 years and the rest of the patients had varying recurrence rate. The late recurrence recorded only one patient at 16 years of treatment by dredging 3 patient had unusual seedling (distance metastasis) in the lungs one patient in the leg and one patient with scalp. All this distance metastasis patents were treated by different modalities. The distance metastasis cannot rule out in any definite criteria. The study concluded that in case of carnoy’s solution, the recurrence rate is slow and safe measure to manage the patient without mutilating surgery.

Ameloblastoma: 25 Year Experience at a Single Institution

Ameloblastoma is a rare, locally aggressive odontogenic neoplasm, accounting for fewer than 1% of head and neck tumors. Recent literature suggests that the initial surgical approach and histologic growth patterns are the most important prognostic determinants in ameloblastoma. The aim of this study was to compare the clinical presentation, management, and outcomes of patients with ameloblastoma with data reported in the literature; the study spanned 2 decades at a single institution. The institution's database was searched for all patients with pathologically confirmed ameloblastoma, diagnosed between 1990 and 2015. The data collected included sex, age, clinical and imaging findings, management, histologic pattern, clearance of surgical margins, length of follow-up, time to recurrence, and disease-related mortality. The potential risk factors of recurrence were evaluated using log-rank test, proportional hazard model, and Fisher exact test. Review of the database yielded 54 patients with pathologically confirmed ameloblastoma and follow-up. Recurrence was noted in 13 (24%) patients. Surgical approach was associated with the risk of recurrence (6.1% following radical resection vs. 52% following limited surgery, p=0.002). There were trends toward higher recurrence rate in the group with pathologically documented positive margins (p=0.054) and in follicular ameloblastoma (p=0.35). Transformation into ameloblastic carcinoma was identified in two patients. There was no disease-related mortality. Our study confirms the recent data regarding the importance of radical surgical resection in management of ameloblastoma. Surgical approach appears to be the strongest predictor of tumor clearance.

Ameloblastomas of the mandible and maxilla.

This review focuses on issues in managing ameloblastomas of the mandible and maxilla. We will refer to current practice in the treatment of ameloblastomas based on the available evidence. Recent reviews have been trying to establish natural history, growth patterns and malignant potential. This provides the clinicians and the patients with useful prognostic information. Controversies in management of ameloblastomas in relation to the type, age and site exist. This paper aims to categorize these issues. More recently, the authors have adopted the staged treatment approach as an additional step to ensure margin clearance. Current evidence favours radical resection to provide better control rates. This applies to maxillary lesions of all ages, and solid mandibular lesions in adults (>18 years) where growth has ceased and the patient has matured enough to withstand the impact of resection and reconstruction. Conservative management is advocated for unicystic lesions with good control rates. In children and adolescents, a conservative approach is recommended. This approach aids to minimize both psychological and the impact on growth. Furthermore, most of the lesions are unicystic and the recurrent lesions have been shown to be much smaller and can be managed promptly within a good healthcare system.

Rational approach to the surgical management of ameloblastoma

Rational approach to the surgical management of ameloblastoma

Management of Ameloblastoma in North Yorkshire- The York Hospital experience over 22 years

Introduction: Ameloblastomas are invasive jaw tumours with a recurrence rate related to surgical and pathological factors. This study looks at 15 cases diagnosed and treated in York and reviews histopathology, surgery, follow-up and recurrence. Method: Retrospective review of medical records and literature review. Results: The histological subtypes were solid/multicystic (53.3%), extraosseous/peripheral (13.3%), unicystic (13.3%) and not specified (20%). The surgical management included no treatment (6.7%), wide resection with reconstruction (60%), enucleation (20%) and marsupialisation (13.3%). Follow-up ranged from 4 194 months with a mean followup of 47 months. 79% of patients are still under review. There was 1 recurrence at 291 months, which was a unicystic subtype treated with enucleation. There was also 1 unconfirmed recurrence at 171 months. Discussion: The literature suggests follow-up for 5-10 years although there was no consensus. However, in our series and in the literature there are late recurrences reported at >10years after treatment. Does radical surgery make long follow-up necessary? Although our results imply that it does not, there is not enough supporting evidence. The commissioners want less hospital follow-up generally, as is the case with review of head and neck cancer patients in keeping with new trends in survivorship. There is need for a national BAOMS audit and database for rare tumours to provide more evidence for practise. Since recurrence is related to surgical management we propose separate follow-up protocols for conservatively treated patients and radically treated patients.

Is there a role for enucleation in the management of ameloblastoma?

This study aimed to determine the appropriate long-term management for ameloblastoma and the role of enucleation in the management of the subtypes of ameloblastoma (solid ameloblastomas, cystic ameloblastomas and peripheral ameloblastomas). They differ in their degrees of aggressive behavior and recurrence rates. This is an evidence-based study with review of relevant articles from PubMed, EMBASE and the Cochrane Library. Articles were categorized for quality according to the Oxford Center of Evidence-Based Medicine (CEBM). 58 articles met the inclusion criteria; their evidence level varied from IIA to V. No randomized control trials were identified. Solid and multicystic ameloblastomas have a high recurrence rate (60-80%) with simple enucleation and require more aggressive treatment. The treatment of choice is resection with 1-cm margins. This may require segmental resection in the mandible, and partial maxillectomy in the maxilla. For the unicystic ameloblastoma recurrence rates are high for simple enucleation. The intraluminal subtype of unicystic ameloblastoma may do well with enucleation, but the intramural subtype may not, and since these cannot be identified preoperatively more aggressive treatment is recommended, including peripheral ostectomy or enucleation with subsequent treatment of the surrounding bone with liquid nitrogen, Carnoy's solution, or similar physicochemical modality. The peripheral ameloblastoma has a different origin and responds to local excision.

O.292 New trend in the management of ameloblastoma

O.292 New trend in the management of ameloblastoma

Re-implantation of autogenous freeze treated mandibular bone in the management of ameloblastomas

Re-implantation of autogenous freeze treated mandibular bone in the management of ameloblastomas