Write in detail clinical fratures radiological features and management of amebloblastoma of mandible
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Abstract Ameloblastoma is a rare odontogenic neoplasm
of the mandible and maxilla, with multiple histologic
variants, and high recurrence rates if improperly treated.
The current mainstay of treatment is wide local excision
with appropriate margins and immediate reconstruction.
Here we review the ameloblastoma literature, using the
available evidence to highlight the change in management
over the past several decades. In addition, we explore the
recent molecular characterization of these tumors which
may point towards new potential avenues of personalized
treatment.
Keywords Ameloblastoma Head and neck surgery
Clinical review Genomics Personalized medicine
SHH BRAF
Introduction
Ameloblastoma is a rare, benign, slow-growing but locally
invasive neoplasm of odontogenic origin involving the
mandible (80 %) and maxilla; conservative treatment results
in a high recurrence rate. The neoplasm was first
described by Cusack in 1827 [1]. Etymologically, the name
derives from the old French word ‘‘amel,’’ which means
enamel, and the Greek word ‘‘blastos,’’ meaning germ or
bud. Over time, this tumor has been referred to by many
different names including ‘‘cystosarcoma,’’ ‘‘adamantine
epithelioma,’’ ‘‘adamantinoma,’’ and finally ‘‘ameloblastoma’’
[2, 3].
Ameloblastoma shows variable geographic prevalence,
being the most common benign odontogenic tumor in
China [4] and Africa [5, 6], while it is the second most
common in the United States and Canada [7, 8] (odontoma
being most common). African Americans have an overall
fivefold increased risk of disease as compared to Caucasians
[8]. Global incidence has been estimated at 0.5
cases per million person years, and most cases are diagnosed
in patients 30–60 years of age [9].
In this review, we summarize the natural history and
clinicopathological variants of ameloblastoma. Diagnostic
evaluation and surgical management of the various histologic
variants of ameloblastoma will be discussed. As
controversy has existed for some time now with regard to
enucleation/curettage versus resection with wide margins,
we will highlight the evidence supporting adequate surgical
bony margins. Additionally, the potential role of adjuvant
radiation and chemotherapy will be addressed. This discussion
is complicated by the lack of a staging system and
the absence of prospective studies for this rare disease, both
of which make it difficult to compare treatment outcomes,
especially when recurrences can occur decades after initial
& Andrew C. McClary
& Davud Sirjani
1 Division of Head and Neck Surgery, Department of
Otolaryngology, Stanford University, 801 Welch Rd.,
MC 5739, Stanford, CA 94305, USA
2 Department of Pathology, Stanford University, 300 Pasteur
Drive, Lane 235, Stanford, CA 94305-5324, USA
3 Division of Oncology, Department of Medicine, Stanford
University, 300 Pasteur Dr., Stanford, CA 94305, USA
4 Department of Pediatrics, Stanford University, 300 Pasteur
Dr., Stanford, CA 94305, USA
5 Department of Radiology, Stanford University, 300 Pasteur
Dr., Stanford, CA 94305, USA
123
Eur Arch Otorhinolaryngol
DOI 10.1007/s00405-015-3631-8
treatment. Lastly, emerging molecular data are improving
our understanding of the pathogenesis of ameloblastoma
and may have treatment implications.