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.

[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.

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.

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.

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.

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.

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.

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 (AU)

[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.

Risk factors predicting aspiration after free flap reconstruction of oral cavity and oropharyngeal defects.

OBJECTIVE: To determine risk factors predicting early postoperative aspiration in patients after microvascular free flap reconstruction of oral cavity and oropharyngeal defects. DESIGN: Retrospective analysis. SETTING: Academic tertiary care referral medical center. PATIENTS: The study included 100 patients who underwent resection of oral cavity or oropharyngeal tumors with immediate free flap reconstruction of the defect. MAIN OUTCOME MEASURES: Dysphagia severity was assessed by modified barium swallow study performed within 90 days after surgery to determine the presence or absence of tracheal aspiration. Aspiration risk factors analyzed included age; sex; tumor T and N stage; comorbidity level (American Society of Anesthesiologists classification); preoperative swallowing function; history of tobacco use; surgical approach used for tumor resection; defect classification; type of free flap; history of radiation therapy, surgery, and/or chemotherapy; and surgical defect classification. RESULTS: The following risk factors were significant predictors of postoperative aspiration on univariate analysis: prior radiation therapy (P < .001), tongue base resection classification (P = .001), tumor N stage (P < .001), hypoglossal nerve sacrifice (P = .004), and presence of a mandibular osteotomy (P = .01). On multivariate analysis, only a history of radiation therapy (P = .002) and tongue base resection (P = .008) remained statistically significant predictors of aspiration. CONCLUSION: Patients with resection of more than half of the tongue base and patients with a history of radiation therapy are at high risk of having early postoperative aspiration after free flap reconstruction.

Ameloblastoma.

The purpose of this article is to review the pertinent literature and discuss the optimal treatment and outcomes for patients with ameloblastoma. Ameloblastoma is an uncommon benign, locally aggressive odontogenic neoplasm that usually occurs in the vicinity of the mandibular molars or ramus. Uncontrolled, ameloblastoma may cause significant morbidity and occasionally death. The median age is approximately 35 years and males and females are equally affected. The majority of ameloblastomas are multicystic, which are more difficult to eradicate than the unicystic and peripheral varieties. Although surgery is the mainstay of treatment, the extent of resection is controversial. Radical resections, including marginal and segmental mandibulectomy, result in local control rates exceeding 90%. In contrast, conservative procedures such as enucleation and/or curettage result in local control rates of approximately 80% and 50% for unicystic and multicystic ameloblastomas, respectively. Limited experience with radiotherapy indicates that it may reduce the risk of progression and result in long-term local control in the occasional patient with incompletely resectable disease. The optimal treatment for ameloblastoma is wide en bloc resection. Radiotherapy may improve the likelihood of local control in the occasional patient with incompletely resectable tumor.

Acanthomatous ameloblastoma of the maxilla of an adult alpaca.

An adult alpaca presented with a large maxillary swelling. Facial trauma or a tooth root abscess was suspected. Radiographically there was a large expansile lesion displacing the right maxillary teeth. An ameloblastoma was diagnosed histologically and palliative radiation therapy was attempted. Because of poor response to therapy and anorexia the animal was euthanized. Necropsy findings confirmed an ameloblastoma of acanthomatous type.

Plexiform ameloblastoma presenting as a sinonasal tumor.

Ameloblastomas are the most frequent odontogenic tumours, accounting for 1% of all tumours of the maxilla and mandible. Sinonasal ameloblastomas are most common between the ages of 55 and 65, and mandibular ameloblastomas between 40 and 50. Incidence is higher in males than in females, and there are no differences between races. These locally aggressive tumours originate in the mandible in 80% of cases and in the maxilla in 15-20%. We report an unusual primary nasosinusal ameloblastoma presented in a 68-year-old male. The tumour was completely resected by (para)lateral rhinotomy and treated with postoperative radiotherapy. Histological analysis demonstrated a plexiform ameloblastoma. The patient remains well without disease after 50 months of postoperative follow-up.

[Intraoperative extracorporeal irradiation and replantation in local treatment of primary malignant bone tumors]. / Intraoperative extrakorporale Irradiation und Replantation (IEIR) in der lokalen Behandlung primär maligner Knochentumoren.

In 13 patients with primary malignant bone tumors (10 Ewing's sarcoma, 1 parosteal osteosarcoma, 1 adamantinoma recurrence, and 1 MFH) local therapy was performed as intraoperative extracorporeal irradiation and replantation (IEIR) of the involved bone segment (5 tibia, 2 femur, and 6 pelvis). Of the 13 patients (69%), 9 are alive at the time of the follow-up (5 CDF, 4 AWM(treated)) and 4 patients died of disease (DOD). Up to now during the follow-up of 32 months (6-57), no local recurrence was observed in the replanted bone segments. The complication rate was very high (18 complications in 11 of the 13 patients, including 6 cases with complication V degrees according to Ruggieri with loss of the reconstruction). The typical complication is severe local infection necessitating removal of the replant. In cases of mechanical failure, the replanted segment could mostly be preserved by surgical revision and autologous bone grafting. If serious complications can be managed or avoided, functional results can be achieved. IEIR must be seen as an extraordinary reconstruction procedure in cases where established procedures such as endoprosthesis, biological reconstructions, or rotationplasties cannot be used or are refused by the patient.

Ameloblastomas maxilares: a propósito de un caso clínico y revisiónde la literatura / Maxillary ameloblastoma: about a clinical case and review of the literature

- Propósito: se revisan los datos epidemiológicos, clínicos, anatomopatológicos y los procedimientos diagnósticos y terapéuticos de los ameloblastomas maxilares.- Material y métodos: se presenta un caso de ameloblastoma de maxilar superior en una mujer de 36 años.- Resultados: se realizó tratamiento con radioterapia postoperatoria tras cirugía radical, dado que se trataba de una lesión extensa en una paciente joven. Tras un seguimiento de 5 años y medio la paciente se encuentra libre de enfermedad.- Conclusiones: se describe el comportamiento de este tumor así como su tratamiento (AU)

Ameloblastoma: revisäo da literatura e relato de caso / Ameloblastoma: review of the literature and case report

A literatura odontológica acerca dos ameloblastomas remonta de várias décadas e, até nossos dias, revela a grande controvérsia existente, seja no quadro histológico, clínico, radiográfico ou terapêutico. O atual estudo faz uma breve revisäo da literatura e relata um caso clínico de hemandibulectomia com reconstruçäo usando-se placa e côndilo de titânio associados ao enxerto ósseo de crista ilíaca