背景:成釉细胞瘤是一种由上皮组织组成的良性肿瘤,在局部水平具有侵袭性和浸润性行为,复发率高,具有各种组织病理学模式和临床形式。大约85%的常规成釉细胞瘤发生在下颌骨,最常见的是在体内,angle,和上升的ramus区域。治疗方式包括保守治疗和根治性治疗。术后随访是成釉细胞瘤治疗的重要手段。
目的:描述接受不同手术方式的下颌骨成釉细胞瘤的临床病理特征。主要目的是描述年龄≥18岁的下颌骨成釉细胞瘤的临床病理特征和手术治疗。在研究期间曾向三级牙科护理中心报告随访。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。
方法:研究了2011年至2021年间接受各种手术方式的34例下颌骨成釉细胞瘤患者。使用预先设计的形式收集信息并进行统计分析。
结果:本研究纳入了34例成釉细胞瘤病例。对患者进行年龄分析,性别,site,尺寸,临床表现,射线照相模式,组织病理学亚型,手术类型,和相关的合并症。下颌成釉细胞瘤的大多数病例年龄在16至55岁之间。平均发病年龄为35.5±13.2。女性优势,肿瘤大小范围为2至4厘米,多基因变异,前磨牙区的下颌体受累,根吸收,皮质穿孔,和滤泡型的组织病理学模式是常见的表现。未发现局限于切牙/犬科区域的孤立的前肿瘤。常见的手术方式是保守的方法,如摘除,和化学烧灼,和根治方法,如下颌骨边缘切除术和节段切除术。在所示病例中,使用钛板或游离腓骨移植物进行重建。常见的合并症包括咀嚼困难和面部轮廓缺失。手术治疗后复发罕见。只有9%的病例在5年内复发。在接受根治性治疗的病例中没有发现复发,而用保守方法治疗的病例中有50%显示复发。
结论:发生年龄,site,和肿瘤的大小,皮质穿孔,根吸收,组织病理学类型,在制定下颌骨成釉细胞瘤的治疗计划时,放射学模式被广泛认为是因素。然而,在罕见的情况下,这些肿瘤无论其无害的临床病理表现如何,都有不同的表现.发现诸如节段性切除术和边缘下颌骨切除术之类的外科手术对于根除肿瘤是有希望的。预防复发和转移。然而,保守措施,如摘除术和化学烧灼术,会增加肿瘤复发和转移的风险.未来样本量较大的研究应集中在成釉细胞瘤的临床病理特征上,以阐明其各种行为,并开发更新和先进的治疗方式,为受影响的患者提供更好的手术和术后结果。
BACKGROUND: 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.
OBJECTIVE: 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.
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.
RESULTS: 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.
CONCLUSIONS: 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.