Oral Pathology Case Report

7/30/2019 Oral Pathology Case Report

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AMELOBLASTOMA

Doloso, Shyra Jane B.

DMD 2- CAD


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Amelobalstoma

A benign, aggressive tumor that is invasive and persistent.

Sometimes its called solid or multicystic ameloblastoma

Adult most commonly affected

Mandibular molar- ramus most commonly affected site

Broad range age range: maen 40 years old

Unilocular or Multilocular

Recurrence rate higher with conservative treatment

No gender predilection

They grow quickly and can change and destroy bone around them

Radiographically it appears osteolytic,typically found at tooth bearing areas of jaws and maybeeither unilocular or multilocular. Margins are usually well defined and sclerotic.

Clinical Features:

facial deformity

difficulty moving your jaw

loosening of your teeth

swelling


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DEFINITION OF TERMS

Ameloblastoma - is a benign odontogenic tumor arising from the residual epithelial

components of tooth development

Hemimandibulectomy- is a procedure whereby one half of the mandible is

removed surgically.

Reconstruction of the mandible - mandible is to restore the shape and function of the face,

the continuity of the mandible and the muscular attachment

Osteotomy is a surgical procedure that involve bone-cutting.

Incision- cutting or surgical cut in the skin or flesh

Hemostasis- act of stopping blood from flowing

Gigli Saw - is another instrument used to carry out osteotomy. The instrument has two handles,

and a lengthwise twisted stainless-steel wire is hooked to them.

Suture is a process of joining two surfaces or edges together along a line by or as if by sewing.


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Patients Information

16 years old

M

Student

Filipino

Complete Patient History

Chief Complain

Namamaga po ang aking baba

My jaw is swelling

History of Present Illness

The patient has history of incision and drainage three years ago and comes for consult because

of the swelling at the left side of his mandible. He was put on antibiotics for a week but noticesthere no change. The swelling becomes bigger and bigger. There is also minimal displacement of

the teeth. The patient requested X-ray examination of his left mandible.

Medical History

Never been hospitalized

Not taking any medications

Does not have an allergies

Dental History

No Restorations

No Extractions


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History of incision and drainage

Social History

He doesnt smoke and He doesnt drink alcohol

Patients Dental Chart


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Diagnostic Findings


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Diagnosis

Preliminary Diagnosis : Ameloblastoma

Tentative Diagnosis : Ameloblastoma

Differential Diagnosis.

Odontogenic Keratocyst

AMELOBLASTOMA

An ameloblastoma is a benign but

locally agressivetumour arising from

the mandible, or less commonly from

the maxilla.

Epidemiology

Ameloblastomas are the second

most common odontogenic

tumor and account for up to a

3rd of such cases.

They are slow growing and tendto present in the 3rd to 5th decades

of life, with no gender

predilection

Pathology

Ameloblastomas (notsurprisingly) arise from

ameloblasts, (part of the

odontogenic epithelium,responsible for enamel

production and eventual crown

formation).

Radiographic Features

Well defined radiolucent area

Rounded or scalloped margin

Some are unilocular but majority

are multilocular

ODONTOGENIC KERATOCYST

An odontogenickeratocyst

(OKC) is a type of developmental

cyst involving the mandible ormaxilla.

Epidemiology

Odontogenickeratocysts typicallypresent in younger patients (2nd -

3rd decades), are often multiple,

and may be seen in either the bodyor ramus of mandible

(approximately 70% of all OKCs),

ormaxilla. There may be male

predilection.

Pathology

OKCs originate from epithelialcell rests (stratified squamous

keratinizing epithelium) found

along the dental lamina and

periodontal margin of the alveolusof the mandible.
http://radiopaedia.org/articles/missing?article%5Btitle%5D=maxillahttp://radiopaedia.org/articles/missing?article%5Btitle%5D=maxilla


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Radiographic Features

Typically rounded. Radiographic

margins are usually well defined

and sclerotic. Multilocular

radiolucencyScalloped

margin.When loculations are large,

the appearance is called as SOAP

BUBBLEappearance

TYPES OF AMELOBLASTOMA

SOLID/ MULTICYSTIC AMELOBLASTOMA

HISTOPATHOLOGICAL SUBTYPES OF SOLID AMELOBLASTOMA

FOLLICULAR

Islands of epithelium resemble dental organ surrounded by mature connective

stroma.Individual follicles show central mass of stellate reticulum like cells surrounded by a

single peripheral layer of ameloblast like cells. 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 by columnar cuboidal cells.Cells within cords are more loosely arranged thanperipheral cells.Supporting stroma is loose and vascular. Cyst formation occurs, not inside

follicles, but in surrounding stroma.

ACANTHOMATOUS

Central area of follicles show extensive squamous metaplasia, often associated with

keratin formation.Does not indicate a moreaggressive course of tumor

Can be confused with squamous cell carcinoma.

GRANULAR CELL

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

BASAL CELL TYPE

Least common typeComposed of nests /sheets of hyperchromatic basaloid cells.No stellatereticulum present centrally and peripheral cells tend to be cuboidal rather than tall columnar


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UNICYSTIC AMELOBLASTOMA

SUBTYPES OF UNICYSTIC AMELOBLASTOMA

o LUMINAL

Tumor is confined to luminal surface of cyst.Seen as fibrous cyst wall with lining

comprised totally / partially of ameloblastic epithelium, showing a basal layer of columnar /

cuboidal reversely polarized cells .Overlying epithelial cells are loosely adhesive, resembling thestellate reticulum of dental organ.

o INTRALUMINAL

This variant shows the tumor from cyst lining protruding into the lumen of cyst.

Intraluminal projections resemble plexiform ameloblastoma in most cases, though not always.

o MURAL

In this type, the fibrous wall of the cyst is infiltrated with typical follicular / plexiform

ameloblastoma.Believed to be more aggressive than other two variants


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TREATMENT

Hemimandibulectomy and Reconstruction of Mandible

Before Surgery :

Evaluate any other medical problems

Pulmonary function test (PFT)

Cardiac stress test to evaluate your heart.

Anesthetic Requirements

GENERAL ANESTHESIA

Surgery

Incision

Hemostasis

Occlusion setting with wiring

Resection of the lesion

Reconstruction of Mandile

Placement of titanium plates with and without bone Graft

Suturing

After Surgery

* Tubes,Drainage,Catheters and Other Medical Devices

>A humidifier collar placed over your trach tube. It will provide moist air to your lungs

> The intravenous (IV) line through which you will receive:


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Fluid.

Antibiotics.

Pain medication.

Anticoagulants (to prevent your body from forming blood clots in the surgical area).

>A Foley catheter to drain urine from your bladder. It is removed two or three days after

surgery.

>A feeding tube through your nose into your stomach. You will get high-protein liquid feedings

and your medicines through this tube. You will not be able to eat and drink until the swelling

from the surgery goes

down.

*Self Care

*Oral Irrigation

As soon as the rubber bands are removed, you will begin irrigating (wetting) your mouth

with salt water and baking soda. This helps keep your mouth clean and moist.

*Diet

Most patients are discharged on a pureed diet. This means that foods have been put through a

blender

*Follow-up Appointments

COMPLICATIONS

Blood clot

Speech and swallowing

Bleeding

Numbness

Infection

Documents

Oral Pathology Case Report