oral path case report nbn

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AMELOBLASTOMAAMELOBLASTOMA


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Amelobalstoma

A benign, aggressive tumor that is invasive andpersistent.

solid or multicystic ameloblastoma

Adult most commonly affected

Mandibular molar- ramus most commonly affected site

Broad range age range: mean 40 years old

Unilocular or Multilocular

Recurrence rate higher with conservative treatment

No gender predilection

They grow quickly and can change and destroy bonearound them


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Radiographic featuresRadiographic features


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Clinical FeaturesClinical Features


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Clinical FeaturesClinical Features


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Types Of AmeloblastomaTypes Of Ameloblastoma

SOLID/ MULTICYSTIC AMELOBLASTOMA HISTOPATHOLOGICAL SUBTYPES OF SOLID

AMELOBLASTOMA

FOLLICULAR

Islands of epithelium resemble dental organsurrounded by mature connective stroma.Individualfollicles show central mass of stellate reticulum like cellssurrounded by a single peripheral layer of ameloblast likecells. Nuclei of peripheral cells are reversely polarized.Within the islands, cyst formation is common.

PLEXIFORM Instead of islands, long, anastomosing cords

and occasional sheets of epithelial cells bounded bycolumnar cuboidal cells.Cells within cords are moreloosely arranged than peripheral cells.Supporting stroma

is loose and vascular. Cyst formation occurs, not insidefollicles, but in surrounding stroma.


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AMELOBLASTOMA

ACANTHOMATOUS

Central area of follicles show extensivesquamous metaplasia, often associated withkeratin formation.Does not indicate a moreaggressive course of tumor

Can be confused with squamous cell carcinoma.

GRANULAR CELL

Follicles / sheets of cells show granular cellchange.These cells have abundant cytoplasm filledwith eosinophilic granules.Seen in younger personsand appears to be more aggressive clinically


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AMELOBLASTOMA

BASAL CELL TYPE

Least common type Composed of nests /sheets ofhyperchromatic basaloid cells. No stellate reticulum present

centrally and peripheral cells tend to be cuboidal rather thantall columnar

UNICYSTIC AMELOBLASTOMA

SUBTYPES OF UNICYSTIC AMELOBLASTOMAo LUMINAL

Tumor is confined to luminal surface of cyst.Seen asfibrous cyst wall with lining comprised totally / partially ofameloblastic epithelium, showing a basal layer of columnar/ cuboidal reversely polarized cells .Overlying epithelialcells are loosely adhesive, resembling the stellatereticulum of dental organ.


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UNICYSTIC AMELOBLASTOMA SUBTYPES OF UNICYSTIC AMELOBLASTOMA

o INTRALUMINAL

This variant shows the tumor from cyst lining protrudinginto the lumen of cyst.

Intraluminal projections resemble plexiform ameloblastomain most cases, though not always.

o MURAL

In this type, the fibrous wall of the cyst is infiltrated withtypical follicular / plexiform ameloblastoma.

Believed to be more aggressive than other two variants


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Patients InformationPatients Information

16 years old

M

Student

Filipino


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Complete Patient HistoryComplete Patient History

Chief Complain

May pamamaga po sa aking

baba

There is swelling at my jaw.


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History of Present IllnessHistory of Present IllnessThe patient has history of incision and

drainage three years ago and comes forconsult because of the swelling at the leftside of his mandible. He was put onantibiotics for a week but notices there no

change. The swelling is still not healing aftera week .There is also minimal displacementof the teeth. The patient requested X-rayexamination of his left mandible.Medical HistoryMedical History

Never been hospitalizedNot taking any medicationsDoes not have any allergies


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Patients DENTAL CHARTPatients DENTAL CHART


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DiagnosisDiagnosis

Preliminary Diagnosis :Ameloblastoma

Tentative Diagnosis : Ameloblastoma

Differential Diagnosis :

Odontogenic Keratocyst

AMELOBLASTOMA


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AMELOBLASTOMA

An ameloblastoma is a benign but locally agressivetumourarising from the mandible, or less commonly from the maxilla.

EpidemiologyAmeloblastomas are the second most common odontogenictumor and account for up to a 3rd of such cases.They are slow growing and tend to present in the 3rd to5th decades of life, with no gender predilection

Pathology, responsible for enamel production and eventual crownformation).Ameloblastomas (not surprisingly) arise from ameloblasts, (partof the odontogenic epithelium

Radiographic FeaturesTypically rounded. Radiographic margins are usually well definedand sclerotic. Multilocular radiolucencyScalloped margin.Whenloculations are large, the appearance is called as SOAPBUBBLE appearance


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ODONTOGENIC KERATOCYST

An odontogenickeratocyst (OKC) is a type ofdevelopmental cyst involving the mandible or maxilla.

EpidemiologyOdontogenickeratocysts typically present in youngerpatients (2nd - 3rd decades), are often multiple, and maybe seen in either the body or ramus ofmandible

(approximately 70% of all OKCs), ormaxilla

. There maybe male predilection.

PathologyOKCs originate from epithelial cell rests (stratifiedsquamous keratinizing epithelium) found along the

dental lamina and periodontal margin of the alveolus ofthe mandible.

Radiographic FeaturesWell defined radiolucent areaRounded or scalloped margin

Some are unilocular but majority are multilocular
http://radiopaedia.org/articles/missing?article[title]=maxillahttp://radiopaedia.org/articles/missing?article[title]=maxilla


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TreatmentTreatment

HEMIMANDIBULECTOMY

And

RECONSTRUCTION of MANDIBLE


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HemimandibulectomyHemimandibulectomy

Before Surgery : Evaluate any other medical problems

Pulmonary function test (PFT)

Cardiac stress test to evaluate yourheart.

Anesthetic Requirements

GENERAL ANESTHESIA

i l d


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Surgical Procedures Surgical Procedures


IncisionIncision

S i l P d


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HemostasisHemostasis

i l dS i l P d


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Occlusion Setting with wiringOcclusion Setting with wiring

urg ca Proce ures urg ca roce ures


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urg ca Proce ures urg ca roce ures HemimandibulectomyHemimandibulectomy

Resection of Mandible with theResection of Mandible with the

lesionlesion


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Reconstruction ofReconstruction of

mandiblemandiblePlacement of titanium plates with

bone graft ( fibula,illiac andothers)


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Reconstruction of mandibleReconstruction of mandible

Placement of titanium plates without bonegraft


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SuturingSuturing

After SurgeryAfter Surgery


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After SurgeryAfter Surgery

Tubes, drains, catheters, and other medicaldevices.

Humidifier Collar ( Tracheostomy )

IV

Foley Catheter

Feeding tube ( Nasogastric Tube Feeding)

Self - Care

Oral Irrigation

Diet Follow-up Appointments


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ComplicationsComplications

Blood clot

Speech and swallowing

Bleeding

Numbness

Infection


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