Treatment Options for Amelobastic Carcinoma of the Mandible: A Case Series and Review of the Literature.

We retrospectively review the only three cases in the Irish National Maxillofacial Unit over a 12-year period. Methods involved retrospectively reviewing clinical notes, radiology and histopathology of three cases. Case one was an 80-year-old male presenting with mandibular swelling, who received radiotherapy alone. Case two was a 26-year-old male with swelling and odynophagia. He underwent left hemimandibulectomy and fibular free flap reconstruction. Case three was a 64-year-old female with mental nerve involvement who underwent a right hemimandibulectomy. The cases presented here illustrate a diverse sample regarding patient demographics and management approaches. Surgery usually necessitates en bloc resection, free flap reconstruction and 1-1.5 cm margins. Adjuvant radiotherapy may be required for close margins.

A clinicopathological study of malignant odontogenic tumours.

AIMS: Malignant odontogenic tumours (MOTs) are rare neoplasms occurring primarily within the jaw. The objective of this study was to determine the incidence, demographics and clinicopathological features of the MOTs from two institutions. METHODS AND RESULTS: The records of the Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand and the Department of Oncology and Diagnostic Sciences, Dental School, University of Maryland, Baltimore, USA were searched from 1991 to 2010; we identified 17 cases of previously diagnosed MOTs. All cases were reviewed independently of the previous diagnosis by two blinded oral pathologists and reclassified based on the 2005 World Health Organization classification of head and neck tumours. In this study we describe in detail these 17 cases which presented with an average age of 50.29 years and a male to female ratio of 2.4:1. These cases included five ameloblastic carcinomas, four atypical ameloblastomas, three primary intraosseous squamous cell carcinomas, three intraosseous mucoepidermoid carcinomas and two clear cell odontogenic carcinomas. All cases were treated by surgical resection and one patient with ameloblastic carcinoma received postoperative radiotherapy. CONCLUSIONS: Malignant odontogenic tumours are considered rare central odontogenic lesions. Awareness of their existence, rapid diagnosis and successful treatment using surgery, radiation and/or chemotherapy is critical to patient survival.

[Ameloblastic carcinoma: primary or secondary?]. / Carcinome améloblastique : primitif ou secondaire ?

Ameloblastic carcinoma is a rare neoplasm. It can arise de novo or in a preexisting benign ameloblastoma. Most cases arise in older patients. The first case report is rare and concerns a man with an ameloblastic carcinoma primary-type of the maxillary. The second case concerns a woman with an ameloblastic carcinoma secondary-type developed on a preexisting follicular ameloblastoma of the mandible. Both patients benefited from an adjuvant radiochemotherapy. The prognosis of such carcinoma must remain guarded over an observation period of several years because of the proximity of the lesion to vital structures.

The use of radiation therapy in the definitive management of ameloblastic carcinoma: a case report.

Although rare, ameloblastic carcinoma (AC) is one of the most common malignant tumors occurring in the odontogenic epithelium. Evidenced-based medical guidelines for AC are not established because AC is a rare type of cancer. However, surgery for AC is the primary initial treatment modality. A few reports suggest that radiotherapy (RTx) is effective for AC; however, the tumor is generally considered to be radioresistant. Furthermore, if RTx is performed for AC, osteonecrosis may occur because most of the ACs arise from the jaw. Here, we report a case of an older patient with maxillary AC who had underlying medical problems and who received conventional RTx with good outcomes. Ten years after the treatment, no major adverse event accompanying irradiation, local recurrence, or metastasis was observed. We discuss the therapeutic effect and usefulness of RTx on AC. As indicated by our findings, RTx for AC may represent a definitive treatment strategy for patients with poor general conditions or those with tumors that cannot be resected completely.

I125 brachytherapy guided by individual three-dimensional printed plates for recurrent ameloblastoma of the skull base.

Ameloblastoma is one of the most common benign odontogenic tumours of the mandible and the maxilla. Wide excision of the tumour is the first choice for treatment (except for unicystic ones). Patients with invaded margins or unresectable lesions may require radiotherapy. Today, permanent implantation of I125 seeds is widely used in the treatment of cancer of the head and neck. We report a case of recurrent ameloblastoma of the base of the skull that was treated with I125 brachytherapy. The outcome has been encouraging, with total disappearance of the tumour on positron emission tomography 18 months later.

[Ameloblastoma of the maxillary sinus treated with radiation therapy]. / Améloblastome du sinus maxillaire traité par radiothérapie.

Ameloblastoma is a benign aggressive odontogenic tumor which requires early diagnosis and appropriate treatment. It commonly affects the mandible and radical surgery is the gold standard treatment. We report the case of a patient with ameloblastoma in extremely advanced phase affecting the maxillary sinus who was treated with intensity modulated conformal radiation therapy. Patient's evolution was marked by complete remission maintained after 24 months follow-up. Maxillary ameloblastoma is not well documented in the literature. It is usually diagnosed at the later stage when optimal surgery cannot be performed. This case study aimed to demonstrate that radiation therapy is a real therapeutic alternative in the treatment of advanced and inoperable forms of ameloblastoma.

Treatment of ameloblastoma of the jaws.

OBJECTIVE: To evaluate treatment of ameloblastoma of the jaws and suggest a more aggressive approach for well-defined cases. SETTING: Referral center. PATIENTS: Forty-one patients were treated for ameloblastoma of the jaws. RESULTS: Seventeen patients had a local recurrence; 14 had initial curettage and three had initial resection. Seven patients had two or more recurrences. Eight patients underwent radiotherapy; two died of progressive disease. CONCLUSIONS: Ameloblastoma had a high rate of local recurrence if not adequately removed. Segmental resection for the mandible and partial maxillectomy for the maxilla should be the primary treatment; marginal resection is appropriate only for small primary tumors. For multiple recurrences, radiotherapy is effective, and surgery and radiotherapy (50 Gy postoperatively) should be used in selected cases.

Ameloblastoma of the jaw. Treatment with radiation therapy and a case report.

Ameloblastoma of the jaw is an aggressive benign tumor of epithelial origin that has generally been treated surgically even for metastases. This article is a review of the literature and a report of a previously unpublished case. Despite earlier reports, it is suggested that the available data clearly indicate that it is a radiosensitive tumor. In this report, specific recommendations for radiation therapy are outlined, and guidelines for treatment planning, radiation dosage, and fractionation expected outcome and follow-up are given.

Combined chemotherapy and radiotherapy for advanced maxillary ameloblastoma. A case report.

A case of advanced maxillary ameloblastoma was successfully treated with combined intra-arterial chemotherapy (Peplomycin, 85 mg) and radiotherapy (Co60, 7080 r). The tumour showed a remarkable shrinkage, and the patient survived. He is still alive and well at the time of this report. Carefully applied chemotherapy combined with radiotherapy has a useful role in the management of ameloblastoma especially in an advanced maxillary tumour. This report presents a typical example, which indicates that the ameloblastoma may not be an inherently radioresistant and chemoresistant tumour.

Radiotherapy in the treatment of ameloblastoma.

There is a lack of well-documented evidence in the literature concerning the relative radioresponsiveness or radioresistance of ameloblastomas, although they are generally considered radioresistant. Most of the previous papers referring to this subject lack acceptable histopathologic proof of the diagnosis, adequate radiotherapeutic data, and/or follow-up information; many predate the use of megavoltage irradiation. The present article reports 5 cases of ameloblastoma that were treated by radiotherapy, 3 by megavoltage irradiation. All have been confirmed histologically by an oral pathologist, all have adequate radiotherapeutic data and, with one exception, adequate follow-up information. In addition, the reasons for our present lack of knowledge of this subject are discussed; objective criteria are presented for evaluating the results of radiotherapy on ameloblastomas; the only other series of ameloblastomas treated by megavoltage irradiation is analyzed. Although radiotherapy can reduce the size of an ameloblastoma, primarily that part of the tumor which has expanded the jaw or broken into the soft tissues, it does not appear to be an appropriate treatment for an operable ameloblastoma. Its main use is in inoperable cases, primarily in the posterior maxilla.

Canine acanthomatous epulis. The only common spontaneous ameloblastoma in animals.

This article describes the acanthomatous epulis in dogs, a quite common lesion that appears to be the counterpart of human ameloblastoma. Histologically, it resembles closely the acanthomatous pattern of human ameloblastoma and, like ameloblastomas in human beings, it infiltrates cancellous bone; moreover, it has no tendency to metastasize. Veterinarians have sometimes treated the acanthomatous epulis with therapeutic irradiation, providing one example when this tumor served as an animal model for human ameloblastoma. Although this treatment has cured some animals, others have developed postirradiation malignancies.

Case report. Aggressive ameloblastoma treated with radiotherapy, surgical ablation and reconstruction.

Surgical resection of aggressive solid or multicystic ameloblastoma is a well-documented and accepted treatment modality. Controversies exist, however, with regard to the extent of operative intervention. Unresectable lesions have been treated with radiation or combined radiation and chemotherapy. The authors present a case report of a patient with recurrent ameloblastoma who underwent simultaneous hard- and soft-tissue reconstruction.

X-ray therapy of selected odontogenic neoplasms in the dog.

X-ray therapy was used on 14 selected adamantinomas and 2 ameloblastic odontomas, with beneficial results. The recommended x-ray treatment is a minimum total dose of 3,600 rads and a maximum of 4,200 rads, at a half-value layer of 1.5 to 2 mm of Cu. Five to 6 treatments were spread over a 10- to 12-day period.

Ameloblastoma of the upper jaw.

A clinical study was made of three cases of Ameloblastoma (Adamantinoma) of the maxilla. One case presented with oro-antral fistula following extraction of a molar tooth. Extensive bone destruction and involvement of ethmoidal air sinuses and nasal cavity was seen in one of the patients. At times histological diagnosis can be difficult; therefore, accurate diagnosis should be obtained by an experienced histopathologist. Partial maxillectomy with a wide margin of healthy bone should be the choice of treatment in the majority of cases. There tumours are sensitive to deep-X-ray to a varying degree. One should consider radiotherapy post-operatively if growth has been excised inadequately. Radiotherapy may be helpful when surgery is contraindicated.

Ameloblastoma of the jaws.

Ameloblastoma is a histologically benign tumor derived from odontogenic apparatus. The tumor can infiltrate into surrounding tissues. Although it is benign, it presents symptoms of a malignant tumor, such as infiltration into the lungs, pleura, regional and distant metastases, orbit, base of skull, brain and has resulted in death. It also has a high incidence of recurrences, the existence of regional or distant metastasis, showing a microscopic pattern of ameloblastic carcinoma with cytologic features of an increasing nuclear/cytoplastic ratio, nuclear hyperchromatism, and the presence of mitosis. We report a study of 12 patients of ameloblastoma of the jaws between January 1992 and December 1996 consisting of 8 affected in the mandible and 4 in the maxilla. One patient with a tumor in the maxilla was excluded from this study, due to a different histological and clinical behaviour of the ameloblastoma.

Prominent response with helical tomotherapy in recurrent ameloblastic carcinoma of maxillary sinus: a case report.

INTRODUCTION: Ameloblastoma is a benign but locally aggressive tumor of odontogenic epithelial tissue. Reports of radiotherapy treatment modalities are limited in the literature. CASE PRESENTATION: A thirty-five year old male presented with complaints of headache radiating to his face for about six months and impaired vision. The patient's Positron Emission Tomography (PET) showed a mass in the left maxillary sinus extending to the nasal cavity and invading the adjacent tissues. An R2 (macroscopic residual tumor) surgical resection performed to debulk the tumor. Due to the recurrence and residual mass, the patient was treated with helical tomotherapy. At 2 months post-radiotherapy, patient's vision returned to normal. PET scan showed a significant reduction in lesion size 12 months post-radiation. CONCLUSION: In cases of ameloblastic carcinoma with, post-surgical recurrence or patients not suitable for surgical treatment, helical tomotherapy can be an effective treatment option.

[Plate related complication after mandibular reconstruction].

OBJECTIVE: To evaluate the complications and factors associated with titanium plates in mandibular reconstruction with different methods. METHODS: A retrospective analysis of 660 patients who received primary reconstruction of the mandible was conducted. The characters of the mandibular defect and methods of reconstruction were recorded. The complications and factors associated with the reconstruction were analyzed. RESULTS: The majority of mandibular defect was in a shape of L (n = 324 ). The total complication rate was 14.7% (97/660), which included screw loosening 5.8% (38/660), plate fracture 3.3% (22/660), plate exposure 3.8% (25/660), infection 7.4% (49/660) and malunion or ununion 2.9% (19/660). The mandibular defects reconstructed by reconstructive plates had a higher complication rate than that by bone grafts. The complication rate was 10.8% (63/586) in cases reconstructed by bone grafts with miniplates. The complications were associated with radiation therapy and diabetes. Radiation therapy had a significant effect on plate exposure. CONCLUSIONS: Reconstruction with bone grafts can minimize the rate of plate related complication. The complications were associated with radiation therapy and diabetes.

Ameloblastoma, a rare benign odontogenic tumour: an interesting tumour review targeting the role of radiation therapy.

Ameloblastoma is known as a benign, slow-growing, rare, odontogenic neoplasm. The solid/multicystic, the unicystic with a fibrous connective-tissue capsule and the peripheral ameloblastoma represent the three well distinguished clinical types of ameloblastoma. Surgical resection with an attempt to achieve adequate free margins constitutes a well documented and accepted treatment modality. Controversies exist, however, with regard to the extent of operative intervention. Patients with inadequate or positive surgical margins or unresectable lesions can be treated with radiation or combined radiation and chemotherapy. The authors present a review of this sparse disease focusing on the special role and efficacy of radiation therapy in its management.