Ameloblastoma surgery: Difference between revisions

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{{Ameloblastoma}}
{{Ameloblastoma}}
{{CMG}}{{AE}}{{Simrat}}
{{CMG}}; {{AE}}{{Simrat}}
==Overview==
==Overview==
The mainstay of therapy for ameloblastoma is surgery. The predominant therapy for ameloblastoma is surgical resection. Adjunctive chemotherapy/radiation/chemoradiation may be required.<ref name="wiki">  Ameloblastoma. Wikipedia(2015) https://en.wikipedia.org/wiki/Ameloblastoma Accessed on December 25, 2015</ref >
The mainstay of therapy for ameloblastoma is [[surgery]]. The predominant therapy for ameloblastoma is [[surgical resection]]. Adjunctive [[chemotherapy]]/[[radiation]]/chemoradiation may be required.


==Surgery==
==Surgery==
Management of ameloblastoma has been controversial due to the unique biological behavior of ameloblastoma as a slow-growing, locally invasive tumor with a high rate of recurrence. Recurrence rates of ameloblastoma are reportedly as high as 75-90% after conservative treatment and 15-25% after radical treatment. Therefore, wide resection of the jaw in accordance with the treatment of malignant tumors is usually recommended for ameloblastomas. Treatment of mandibular ameloblastoma continues to be controversial. It can change with various factors listed below. Treatment consists of wide resection, curettage and enucleation. Where the lower border of the mandible is not affected by the tumor conservative treatment of ameloblastoma by enucleation and bone curettage is done.<ref name="pmid16026635">{{cite journal| author=Gümgüm S, Hoşgören B| title=Clinical and radiologic behaviour of ameloblastoma in 4 cases. | journal=J Can Dent Assoc | year= 2005 | volume= 71 | issue= 7 | pages= 481-4 | pmid=16026635 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16026635  }} </ref>
*[[Surgery]] is the mainstay of treatment for [[ameloblastoma]].<ref name="pmid16026635">{{cite journal| author=Gümgüm S, Hoşgören B| title=Clinical and radiologic behaviour of ameloblastoma in 4 cases. | journal=J Can Dent Assoc | year= 2005 | volume= 71 | issue= 7 | pages= 481-4 | pmid=16026635 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16026635  }} </ref><ref name="pmid25548685">{{cite journal |vauthors=Singh M, Shah A, Bhattacharya A, Raman R, Ranganatha N, Prakash P |title=Treatment algorithm for ameloblastoma |journal=Case Rep Dent |volume=2014 |issue= |pages=121032 |date=2014 |pmid=25548685 |pmc=4274852 |doi=10.1155/2014/121032 |url=}}</ref>


Treatment decisions for ameloblastoma are based on the following factors:<ref name="pmid16026635">{{cite journal| author=Gümgüm S, Hoşgören B| title=Clinical and radiologic behaviour of ameloblastoma in 4 cases. | journal=J Can Dent Assoc | year= 2005 | volume= 71 | issue= 7 | pages= 481-4 | pmid=16026635 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16026635  }} </ref>
* Recurrence rates of ameloblastoma are reportedly as high as 75-90% after conservative treatment and 15-25% after radical treatment.<ref name="pmid24137230">{{cite journal |vauthors=Infante-Cossio P, Prats-Golczer V, Gonzalez-Perez LM, Belmonte-Caro R, Martinez-DE-Fuentes R, Torres-Carranza E, Gacto-Sanchez P, Gomez-Cia T |title=Treatment of recurrent mandibular ameloblastoma |journal=Exp Ther Med |volume=6 |issue=2 |pages=579–583 |date=August 2013 |pmid=24137230 |pmc=3786835 |doi=10.3892/etm.2013.1165 |url=}}</ref>
*Anatomical location
* Wide resection of the [[jaw]] in accordance with the treatment of [[malignant tumors]] is usually recommended for ameloblastomas.
*Clinical behavior of the tumor
* Treatment consists of:
*Age
** Wide resection
*General state of health of the patient
** [[Curettage]] 
*Size
**[[Enucleation]]
*Histologic variant
 
*Clinicoradiologic variant
* Treatment decisions for ameloblastoma are based on the following factors:<ref name="pmid16026635">{{cite journal| author=Gümgüm S, Hoşgören B| title=Clinical and radiologic behaviour of ameloblastoma in 4 cases. | journal=J Can Dent Assoc | year= 2005 | volume= 71 | issue= 7 | pages= 481-4 | pmid=16026635 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16026635  }} </ref>
*Surgery is the most common treatment of this tumor. Excision of normal tissue near the tumor margin is often required, because of the invasive nature of the growth. ameloblastoma has tendency to spread to adjacent bony and sometimes soft tissues without metastasizing.  
 
*Although ameloblastoma is not a cancer that actually invades adjacent tissues, it is suspected to spread to adjacent areas of the jaw bone via marrow space. Thus, wide surgical margins that are clear of disease are required for a good prognosis. This is very much like surgical treatment of cancer.  
**Anatomical location
*Often, treatment requires excision of entire portions of the jaw. Surgery is the only effective method for removing the excess tissue growth. A wide surgical excision is often required; in majority of cases, a part of the bone beneath the growth must be removed as well. Surgical curettage of the bone tumor is another treatment modality- although, there is a higher chance of recurrence with this treatment method.  
**Clinical behavior of the [[tumor]]
*Since, surgery is a highly effective method to treat ameloblastoma, in most situations, chemotherapy and radiation treatment is not preferred. Facial reconstructive surgeries may be required, after removal of the tumor. Radiation is ineffective in many cases of ameloblastoma. There have also been reports of sarcoma being induced as the result of using radiation to treat ameloblastoma. Chemotherapy is also often ineffective. However, there is some controversy regarding this and some indication that some ameloblastomas might be more responsive to radiation that previously thought.<ref name="wiki">  Ameloblastoma. Wikipedia(2015) https://en.wikipedia.org/wiki/Ameloblastoma Accessed on December 25, 2015</ref >
**Age
**General state of health of the patient
**Size
**[[Histologic]] variant
**Clinicoradiologic variant
*Surgery is the most common treatment of this tumor. [[Excision]] of normal tissue near the tumor margin is often required, because of the [[invasive]] nature of the growth. Ameloblastoma has tendency to spread to adjacent [[Bony mass|bony]] and sometimes [[Soft tissue|soft tissues]] without metastasizing.
*Although, ameloblastoma is not a cancer that actually invades adjacent [[tissues]], it is suspected to spread to adjacent areas of the [[mandible]] via marrow space. Thus, wide surgical margins that are clear of disease are required for a good [[prognosis]]. This is very much like surgical treatment of [[cancer]].
*Often, treatment requires excision of entire portions of the jaw. [[Surgery]] is the only effective method for removing the excess tissue growth. A wide surgical excision is often required; in majority of cases, a part of the bone beneath the growth must be removed as well. Surgical [[curettage]] of the bone tumor is another treatment modality- although, there is a higher chance of recurrence with this treatment method.  
*Since, [[surgery]] is a highly effective method to treat ameloblastoma, in most situations, [[chemotherapy]] and radiation treatment is not preferred. Facial reconstructive surgeries may be required, after removal of the [[tumor]]. [[Radiation]] is ineffective in many cases of ameloblastoma. There have also been reports of sarcoma being induced as the result of using radiation to treat ameloblastoma. [[Chemotherapy]] is also often ineffective. However, there is some controversy regarding this and some indication that some ameloblastomas might be more responsive to radiation that previously thought.


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
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Latest revision as of 19:00, 23 October 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

The mainstay of therapy for ameloblastoma is surgery. The predominant therapy for ameloblastoma is surgical resection. Adjunctive chemotherapy/radiation/chemoradiation may be required.

Surgery

  • Recurrence rates of ameloblastoma are reportedly as high as 75-90% after conservative treatment and 15-25% after radical treatment.[3]
  • Wide resection of the jaw in accordance with the treatment of malignant tumors is usually recommended for ameloblastomas.
  • Treatment consists of:
  • Treatment decisions for ameloblastoma are based on the following factors:[1]
    • Anatomical location
    • Clinical behavior of the tumor
    • Age
    • General state of health of the patient
    • Size
    • Histologic variant
    • Clinicoradiologic variant
  • Surgery is the most common treatment of this tumor. Excision of normal tissue near the tumor margin is often required, because of the invasive nature of the growth. Ameloblastoma has tendency to spread to adjacent bony and sometimes soft tissues without metastasizing.
  • Although, ameloblastoma is not a cancer that actually invades adjacent tissues, it is suspected to spread to adjacent areas of the mandible via marrow space. Thus, wide surgical margins that are clear of disease are required for a good prognosis. This is very much like surgical treatment of cancer.
  • Often, treatment requires excision of entire portions of the jaw. Surgery is the only effective method for removing the excess tissue growth. A wide surgical excision is often required; in majority of cases, a part of the bone beneath the growth must be removed as well. Surgical curettage of the bone tumor is another treatment modality- although, there is a higher chance of recurrence with this treatment method.
  • Since, surgery is a highly effective method to treat ameloblastoma, in most situations, chemotherapy and radiation treatment is not preferred. Facial reconstructive surgeries may be required, after removal of the tumor. Radiation is ineffective in many cases of ameloblastoma. There have also been reports of sarcoma being induced as the result of using radiation to treat ameloblastoma. Chemotherapy is also often ineffective. However, there is some controversy regarding this and some indication that some ameloblastomas might be more responsive to radiation that previously thought.

References

  1. 1.0 1.1 Gümgüm S, Hoşgören B (2005). "Clinical and radiologic behaviour of ameloblastoma in 4 cases". J Can Dent Assoc. 71 (7): 481–4. PMID 16026635.
  2. Singh M, Shah A, Bhattacharya A, Raman R, Ranganatha N, Prakash P (2014). "Treatment algorithm for ameloblastoma". Case Rep Dent. 2014: 121032. doi:10.1155/2014/121032. PMC 4274852. PMID 25548685.
  3. Infante-Cossio P, Prats-Golczer V, Gonzalez-Perez LM, Belmonte-Caro R, Martinez-DE-Fuentes R, Torres-Carranza E, Gacto-Sanchez P, Gomez-Cia T (August 2013). "Treatment of recurrent mandibular ameloblastoma". Exp Ther Med. 6 (2): 579–583. doi:10.3892/etm.2013.1165. PMC 3786835. PMID 24137230.

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