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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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Types Of AmeloblastomaTypes Of Ameloblastoma
SOLID/ MULTICYSTIC AMELOBLASTOMA HISTOPATHOLOGICAL SUBTYPES OF SOLID
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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Types Of AmeloblastomaTypes Of Ameloblastoma
SOLID/ MULTICYSTIC AMELOBLASTOMA HISTOPATHOLOGICAL SUBTYPES OF SOLID
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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Types Of AmeloblastomaTypes Of Ameloblastoma
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]=maxilla7/30/2019 Oral Path Case Report nbn
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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
HemimandibulectomyHemimandibulectomy
IncisionIncision
S i l P d
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Surgical Procedures Surgical Procedures
HemimandibulectomyHemimandibulectomy
HemostasisHemostasis
i l dS i l P d
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Surgical Procedures Surgical Procedures
HemimandibulectomyHemimandibulectomy
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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