Ameloblastoma is the benign odontogenny tumor of maxillofacial localization causing destruction of a bone tissue. In process of development of an ameloblastoma there is an asymmetry of the person, there is a gradual deformation of a jaw, shaking and shift of a tooth alignment, violation of chewing function. Ameloblastoma is diagnosed on the basis of the anamnesis, symptoms revealed during survey and necessary researches: X-ray analysis, computer tomography, cytologic analysis, etc. Treatment of a disease is performed in exclusively surgical way and consists in a resection of an affected area of a maxillary bone or an exarticulation of a jaw.
Ameloblastoma is the most frequent form of an odontogenny tumor which meets in practice of surgical stomatology. More than in 80% of cases of an ameloblastom arises on the lower jaw, the top jaw is surprised less often. Meets identical frequency at men and at women, usually at the age of 20–60 years. Development of an ameloblastoma in children and teenagers is possible - it the disease makes 6–7% of number of all good-quality formations of zubochelyustny localization at children's age.
Statistically, at a considerable part of patients of an ameloblastom comes to light at rather early stages (1–6 months) that is very important for successful treatment. Quite often the ameloblastoma is found out after a X-ray analysis concerning other dental disease though also late to the doctor (take place with disease duration from 1 year to several years) when the tumor developed already on the considerable site. Ameloblastoma quite often recurs, and at the adverse course and neglect of a disease the malignization (ozlokachestvleniye) of good-quality education is possible.
Reasons and classification of an ameloblastoma
Now there are several hypotheses of the reasons of development of this tumor. Some scientists assume communication of a disease with pathology of development of a tooth rudiment, others consider that the ameloblastoma arises from the odontogenny epitelialny remains (so-called islands of Malasse). Anyway, the exact reasons of development of pathology are not established yet.
Clinically allocate two forms of a disease – cystous and solid (massive). The cystous ameloblastoma is the most widespread, it is characterized by existence of the isolated or partially connected cysts which are covered by a thin epitelialny cover from within. As difference of a massive ameloblastoma serves availability of spongy fabric and sometimes radiological not defined cysts of various size which at long development of pathology gradually merge in one or several large cavities.
Microscopically distinguish several types of a tumor: follicular, pleomorfny, akantomatozny, basal and cellular and granular and cellular. The first two types of an ameloblastoma meet most often, but often within one tumor it is possible to meet different types of a histologic structure. Existence of separate islands (follicles) from epitelialny cages which settle down in Strom from connecting fabric is characteristic of a follicular ameloblastoma. The Pleomorfny ameloblastoma represents an extensive network odontogenny epitelialny tyazhy. At an akantomatozny ameloblastoma the expressed planocellular metaplaziya with formation of a keratin in areas of tumor cells is observed. The basal and cellular ameloblastoma is very similar to basal and cellular cancer, and the granular and cellular form is characterized by high content of acidophilic granules in an epithelium. Existence of cages of two types is characteristic of an ameloblastoma: star-shaped and cylindrical. The last matter in a disease recurrence as possess the long epitelialny shoots overstepping in healthy fabric the bounds of a tumor.
Development of an ameloblastoma happens very slowly, and the patient a long time can not notice any symptoms. However with progressing of a disease the jaw is deformed. As the first visible display of a disease serves violation of symmetry of the person, a swelling from defeat. It should be noted that degree of asymmetry can differ: from small to much expressed. Ameloblastoma of the top jaw meets much less often, but can proceed even more imperceptibly visually as the tumor extends in a maxillary bosom.
When the tumor begins to damage structure of a bone tissue, the patient has a pain which he can take for tooth. There is a shaking and shift of teeth. The jaw in the place of defeat is gradually deformed, and at further progressing of pathology the kortikalny plate becomes thinner – the characteristic pergament crunch appears. At a palpation the blown-up site of a bone smooth or hilly veretenoobrazno is defined, when thinning the bone tissue easily caves in and springs. From an oral cavity it is possible to observe deformation of an alveolar shoot.
Integuments over the struck area long time remain not changed, mobile, easily gather pleated. At development of an ameloblastoma on the top jaw the alveolar shoot and a hard palate are deformed, there is a high probability of spread of a tumor to a nasal cavity and an eye-socket. The course of a disease can be complicated by inflammatory processes - quite often in an oral cavity fistulas with serous and purulent allocations are found. At adverse development or long-term incorrect treatment perhaps ozlokachestvleny tumors, it occurs approximately in 4% of cases.
Diagnostics of an ameloblastoma
Ameloblastoma is diagnosed by the stomatologist on the basis of the anamnesis, the clinical manifestations and data obtained during inspection: a X-ray analysis, a computer tomography, a cytologic research etc. Ameloblastoma is differentiated from dental cysts of an inflammatory etiology, tsistadenoidny carcinoma of salivary gland and planocellular cancer. In diagnostics the radiographic research is of great importance: an orthopan-tomography, an axial (axial) X-ray analysis, a picture in a side projection and a X-ray analysis of an alveolar shoot "in a bite" if necessary. Roentgenograms of the struck area in various projections allow to define rather precisely degree and the amount of education, structure of the center, tumor border, a condition of a kortikalny plate, etc.
The most informative for exact diagnostics of an ameloblastoma is the cytologic research of a punktat of education. In the analysis fat and granular cells, uniform elements of blood, a cage of a flat epithelium, fibrous fibrin, star-shaped cells and crystals of cholesterol are found. This research allows to confirm existence of a benign tumor precisely.
Treatment of an ameloblastoma
Treatment of a disease consists in surgical removal of the site of a jaw affected with a tumor within healthy fabrics. The volume of a resection of a bone tissue depends on the sizes, localization and neglect of pathology.
Now seldom cases when the ameloblastoma reaches the big sizes meet, most often find it at early stages. At early diagnosis of a tumor modern surgical methods allow to remove it without resection or a partial exarticulation of a jaw. Such operations do not break a jaw continuity, quite often allow to keep its functions and to avoid a disfiguration of the face of the patient. For prevention of development of a recurrence of a disease, a wall of a postoperative cavity process the concentrated phenol solution that epitelialny elements of an ameloblastoma underwent a necrosis.
In case of considerable development of a tumor, the resection of a jaw or its partial exarticulation is made (with violation of a continuity). At the ameloblastoma complicated by suppuration simultaneous surgical elimination of inflammatory process and removal of a tumor is carried out. Before surgical intervention sanitation of an oral cavity is surely made. Operation is carried out under the general or local anesthesia.
Postoperative complex treatment always includes antibacterial, symptomatic and corrective therapy. The diet after removal of a tumor should not contain rough and firm products, after acceptance of food it is necessary to wash out a postoperative cavity. In case of loss by the patient of considerable volume of a bone tissue apply bone plasticity to restoration of function of a jaw and make orthopedic designs. Besides, at a disfiguration of the person owing to operation the social aspect of rehabilitation of the patient in which the psychologist can take part is of great importance.
Forecast and prevention of an ameloblastoma
For successful treatment of an ameloblastoma with the smallest consequences early diagnosis of a disease has huge value. In case of timely detection and the correct surgical treatment of an ameloblastoma the forecast encouraging. To avoid serious consequences and irreplaceable losses of a bone tissue, it is necessary to get advice of the stomatologist at the first suspicious symptoms and to undergo inspection. Besides, for ensuring early diagnostics of an ameloblastoma it is recommended regularly (1 time in half a year) to visit the doctor for performing routine inspection.