Oncology >>>> Ameloblastoma of the lower jaw
Ameloblastoma of the lower jaw.
Ameloblastoma of the lower jaw is a non-malignant tumor-like formation, histologically similar in structure to the epithelium of the tooth germ that forms the tooth enamel. For this reason, the second name of this disease, "adamantinoma", comes from the word "substantia adamantina" (enamel).
The most common location of ameloblastoma (adamantinoma) is the angle of the lower jaw, its branches, the area of the lower jaw in the region of the chewing teeth (premolars and molars).
Adamantinoma of the lower jaw clinically develops in different ways, has two forms: cystic and solid. The cystic form of ameloblastoma is a void in the bone tissue, separated by septa. The cavities are usually filled with a colloid-like substrate. For the correct diagnosis, cystic ameloblastoma is differentiated from odontogenic cysts. Solid ameloblastoma has one chamber (capsule), oval or rounded, empty or filled with fluid. Solid ameloblastoma is differentiated from osteoblastoclastoma and malignant tumors.
Outwardly, ameloblastoma looks like a tumor-like growth that changes the contours of the face, causing asymmetry. At the initial stages of the formation of ameloblastoma, no discomfort may be observed. But as it grows, the ameloblastoma deforms the lower jaw, the dentition, leads to loosening of the chewing teeth located above it, interferes with the movements of the temporomandibular joint, and causes problems with chewing and swallowing. There are known cases of suppuration of ameloblastoma, which are accompanied by edema of soft tissues in the area of its location, sometimes the formation of fistulas is complicated . Neglected cases are accompanied by swelling and bleeding of the mucous membrane adjacent to the site of formation of the ameloblastoma. Sometimes the signs of ameloblastoma resemble those of acute osteomyelitis or phlegmon.
Ameloblastoma develops slowly, but in some cases (4% of the total number of ameloblastomas encountered), its growth can significantly accelerate, which indicates a malignancy of this neoplasm.
Treatment of ameloblastoma (adamantinoma) involves its radical removal, but the extent of surgical intervention depends on the degree of damage to the bone tissue structures of the lower jaw. As a rule, the surgeon tries to preserve the mandibular margin in the case when the adamantinoma has not yet managed to destroy the cortical plate of the lower jaw and has not spread to soft tissues. After tumor removal, the walls of the postoperative cavity are treated with a high concentration phenol solution to cause necrosis of the remaining adamantinoma elements to prevent its recurrence.
In the case of resection of the lower jaw when removing ameloblastoma, after healing, bone grafting and prosthetics of the dentition are indicated.
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