109例成釉细胞瘤患者复发相关因素分析研究

目的　探讨成釉细胞瘤临床特征、病理类型及治疗方法与其复发之间的关系。方法　对109例成釉细胞瘤患者的临床病理特征及术后随访资料进行回顾性研究。采用Kaplan-meier方法及Cox回归分析,分析各相关因素与患者复发之间的相关关系,并绘制相关因素下的生存曲线。结果　发生于上颌骨者的复发率为50%,高于下颌骨的26.7%（P=0.004）。病程大于12个月者的复发率高于小于12个月者（P=0.002）。刮除术治疗组的复发率为50.9%（27/53）;切除术（包括方块切除、节段性切除及颌骨半切除）治疗组的复发率为7.1%（4/56）,不同术式间的复发率有显著性差异(P<0.001)。109例成釉细胞瘤患者中,实性型复发率为28.8%(23/80),单囊型复发率为27.6%(8/29),两者无显著性差异（P>0.05）;在实性型成釉细胞瘤中,病理类型与复发有关,其中,丛状型预后较好（P<0.05）。结论　发病部位、病程长短、手术方式及病理类型是影响成釉细胞瘤复发的相关因素,设计治疗方案时,应根据患者的临床特征及病理类型等因素综合考虑。     

92例上颌骨成釉细胞瘤不同手术方式的效果评价

目的:探讨上颌骨各型成釉细胞瘤合适的手术治疗方法.方法:回顾分析92例上颌骨成釉细胞瘤患者的临床资料,所有患者病理诊断明确,术后随访3～8年,定期拍摄颌面部CT、全景片,观察手术治疗效果.采用SPSS 22.0软件包对数据进行统计学分析.结果:上颌骨成釉细胞瘤男女比例为3∶1,男性较多,平均年龄为45.77岁.92例患...     

Controversies in ameloblastoma management: evaluation of decision making,based on a retrospective analysis

Background The ameloblastoma management is still challenging to the high recurrence rates and significant morbidity associated with radical treatment. The purpose of this 10-year retrospective study was to analyze the influence of ameloblastoma type and treatment strategy on the long-term outcomes and recurrence rates. Material and Methods The retrospective analyses of 64 histologically-confirmed ameloblastoma cases was performed. The possible risk factors for recurrence and the development of complications were estimated statistically. Results The treatment strategy applied for this group of patients was the following: thirty-four patients (53.1%) were treated conservatively with enucleation or extended bone curettage. Radical treatment (bone resection) was applied in 30 (46.9%) cases. The follow-up period ranged from 2 to 10 years (mean value 4.28 ± 3,26). General recurrence rate consisted 32.8%. This study did not find significant correlations between clinical or histopathological features of the ameloblastoma and the recurrence rate. The only factor that significantly influence recurrence rate was the treatment strategy (41% in conservative treatment vs 15% in radical treatment, p<0.05). Postoperative complications were observed in 42 patients (65.6%) and included face asymmetry and disfigurement (17.2%), temporary paresthesia of the inferior alveolar nerve (IAN) - 23.4%, permanent paresthesia of IAN - 20.3%, paresis of a marginal branch of the facial nerve - 6.3%, infection 12.5%, and swelling - 20.3%. The complication rates, esthetic and functional deficiency were significantly higher in radically treated patients (p<0.05) Conclusions Our study confirms that higher recurrence rate is associated with conservative treatment for ameloblastoma, while radical treatment leads to an increased number of postoperative complications that affect the patient''s quality of life. Key words:Ameloblastoma, ameloblastoma recurrence, odontogenic tumor, oral pathology.     

Marsupialisation for the treatment of unicystic ameloblastoma of the mandible: a long-term follow up of 116 cases

Unicystic ameloblastoma is a unique histopathological type of ameloblastoma, and treatment is controversial. Marsupialisation is effective in reducing the size of cystic lesions and their complications. We have retrospectively analysed the clinical, histopathological, and prognostic data of affected patients who were treated by marsupialisation between 2003 and 2013 in three Chinese hospitals. Our aim was to evaluate the effects and prognosis, and the factors associated with outcome. A total of 116 patients with mandibular unicystic ameloblastomas were included, and 74, 26, and 16 patients were histopathologically classified as being luminal, intraluminal, and mural subtypes, respectively. Most responded well to marsupialisation, with an overall recurrence rate of 12%. Resorption of the root (p < 0.001), perforation of the cortical bone (p = 0.005), and histopathological subtype (p = 0.013) were the main factors that predicted the outcome. Perforation of the cortical bone was the only reliable predictor of recurrence (p < 0.001). Disease-free survival function curves indicated that patients with the mural subtype were at a higher risk of recurrence than patients with the other two subtypes (p = 0.003). Poor outcomes of marsupialisation were treated surgically and, to date, no subsequent recurrences have been reported. Marsupialisation is effective for these patients, with a recurrence rate similar to that of radical treatment. The outcomes can be predicted using characteristics of the lesion such as resorption of the root, perforation of the cortical bone, and histopathological subtypes. However, additional studies are required to corroborate these findings.     

Analysis of BRAF V600E expression and disease-free survival in patients with ameloblastoma

The correlation between BRAF mutation and the aggressiveness of ameloblastoma remains controversial. The aim of this study was to investigate the association of BRAF V600E expression with clinicopathological features and disease-free survival (DFS) in patients with ameloblastoma. Seventy-four conventional ameloblastoma samples were collected. Immunohistochemistry using anti-BRAF V600E antibody was performed on formalin-fixed, paraffin-embedded tissue sections. Clinicopathological characteristics and treatment outcomes were retrieved from the patient medical records. BRAF V600E immunoreactivity was detected in 50/74 cases (67.6%); 39 were strongly positive and 11 weakly. There was a significant difference in BRAF V600E expression between ameloblastoma and dental follicle (P = 0.034). However, there was no significant association of BRAF V600E expression with any clinicopathological features, including sex, age, location, duration, tumour size, radiographic appearance, cortical perforation, recurrence, and histological subtype. DFS analysis revealed that patients with BRAF-mutated ameloblastoma had a shorter median survival time (84 months vs 168 months) and lower 5-year survival rate (59% vs 67%) compared to the BRAF wild-type group; however, this was not statistically significant (P = 0.169). Moreover, logistic regression analysis revealed that treatment with enucleation was an independent risk factor for tumour recurrence (odds ratio 9.236; P = 0.028). This study demonstrated that the BRAF V600E mutation was not associated with any clinicopathological features of ameloblastoma. A trend towards earlier recurrence in tumours with BRAF mutation was observed, but this requires further investigation. Furthermore, the findings suggest that the treatment modality is an important factor in determining recurrence in ameloblastoma despite genetic alterations.     

开窗减压术联合Ⅱ期手术治疗颌骨成釉细胞瘤的疗效分析：临床回顾性研究

目的　研究开窗减压术联合Ⅱ期手术及单纯刮治术、单纯切除术治疗颌骨成釉细胞瘤（ameloblastoma，AM）的疗效，为临床治疗方案的选择提供参考。方法　对92例颌骨AM患者进行回顾性分析，通过image j软件测量，运用配对t检验和卡方检验分析开窗减压术联合Ⅱ期手术治疗的有效率、颌骨恢复量及下牙槽神经损伤率。运用卡方检验、cox多因素回归模型及Kaplan-Meier等方法评估分析颌骨AM患者的复发率，探究年龄、性别、发病部位、组织病理分型、不同手术方法对于颌骨AM复发率的影响。结果　92例患者的年龄分布为8～76岁，其中0~20岁16例、20~40岁42例、40岁以上34例。性别分布男54例，女38例。根据临床分型分为单囊型33例，经典型 59例。根据组织病理学分为：单囊型：33例；滤泡型：28例；丛状型：24例；基底细胞型：5例；棘皮瘤型：1例；颗粒细胞型：1例。行单纯刮治术治疗的42例，行单纯切除术的25例，行开窗+II期手术的25例。开窗减压术治疗下颌骨AM患者中可测量患者的有效率为77.8%，病变平均缩小率为52.7%（P＜0.05）。可测量的颌骨AM患者中14例开窗减压术前的瘤腔周围最薄处颌骨厚度＜5 mm，经开窗减压术后恢复至5 mm以上（P＜0.05）。开窗减压术+Ⅱ期刮治手术治疗下颌骨AM后的下唇麻木率为31.6%，行单纯刮治术治疗后的下唇麻木率为36.1%(P＞0.05)。92例患者中33例复发，总复发率为35.9%，开窗+Ⅱ期刮治术复发率（21.05%）比单纯刮治术复发率（54.76%）更低（P＜0.05），单纯切除术（24%）比单纯刮治术（54.76%）复发率更低（P＜0.05）。性别、年龄、病理分型、发病部位、开窗与否、手术方式的多因素cox回归检验显示这些因素对颌骨AM复发的影响无统计学意义（P＞0.05）。刮治术，开窗+刮治术，切除术的3年累积复发率分别为24.39%，16%，4%。结论　开窗减压术能降低颌骨成釉细胞瘤瘤腔面积，增加骨厚度，有利于成釉细胞瘤患者的颌骨保存。开窗+II期刮治术以及单纯切除术相对单纯刮治术均能降低成釉细胞瘤患者复发率。同时，开窗减压术不会增加II期手术的复发风险。     

Unicystic ameloblastoma: analysis of surgical management and recurrence risk factors

Unicystic ameloblastoma is a distinct pathological variant with varying evidence published about its behaviour and surgical management. Due to a paucity of large studies in the literature with long-term follow up, the aim of this study was to analyse its surgical management and identify clinicopathological features associated with recurrences. All histopathologically confirmed lesions diagnosed at two referral centres between 1995 and 2020 were retrospectively analysed. Demographic, clinical, radiological, and histopathological features were analysed along with surgical methods and follow-up data. Univariate regression analyses were performed to identify risk factors for recurrence. Sixty-three patients were included in the study with mean age of 26.3 years and a male to female ratio of 1:0.75. The majority of lesions occurred in the posterior mandible (57.1%) and were unilocular (88.9%). Most lesions were managed with enucleation followed by application of Carnoy’s solution (ferric chloride: 1g; chloroform: 3 mL; glacial acetic acid: 1 mL; ethyl alcohol 96%: 6 mL) and burring of the peripheral bone margin which resulted in the lowest recurrences (9.1%) besides resection. Significantly associated clinicopathological features with recurrences included patients who were male, large lesions (>90 mm), presence of root resorption, cortical perforation, mural subtype, and retention of associated teeth. In conclusion, decision making in the management of unicystic ameloblastoma should be based on the clinicopathological features and not be solely based on the histopathological subtype. Enucleation followed by application of Carnoy’s solution and burring of the peripheral bone margin was demonstrated to be the least invasive method with an acceptable low recurrence rate.     

自体移植骨中复发性成釉细胞瘤2例报告及文献复习

报告2例因右下颌骨成釉细胞瘤行右侧下颌骨部分切除或半侧下颌骨切除术后即刻分别行自体髂骨或肋骨移植的病例,2例病例在行X线检查时分别于术后16年和14年在移植骨中发现成釉细胞瘤复发。例1行术中冷冻切片活检,病理学诊断为滤泡型成釉细胞瘤。结合本组2例病例,并对已发表的文献进行复习,认为成釉细胞瘤发生在肿瘤切除植骨后的骨中属于罕见病例,应对其复发机制进行深入研究。     

51例成釉细胞瘤局部复发的临床分析

目的　分析成釉细胞瘤不同病理类型和不同手术方法对术后复发的影响。方法　作者收集 1990～1999年 10年间收治的成釉细胞瘤 5 1例的完整病史进行统计分析。结果　 5 1例中 ,有 2 4例复发 (2 4 /5 1,4 7% ) ,以滤泡型和丛状型为基本类型 ,共 15例 ;共计手术 6 5人次 ,其中单纯摘除者 39人次 ,30人次复发 ;颌骨方块或部分切除及扩大切除者有 2 6人次 ,复发 11人次。结论　成釉细胞瘤的病理学分型不能提示其术后复发与否 ,不同手术方式的术后复发率显著不同 ,颌骨方块或部分切除及扩大切除都能明显降低术后复发率     

分期治疗实性型成釉细胞瘤的初步疗效观察

目的 探讨实性型成釉细胞瘤分期治疗的可行性.方法 对13例实性型成釉细胞瘤患者采取分期手术治疗,一期采用刮除术加开窗术治疗,二期手术去除残余组织并磨除相邻骨质,术后定期X线片追踪观察疗效.结果 13例患者中3例患者一期手术后失访.10 例经术后1～4年追踪观察,9例效果满意,原肿瘤区骨质恢复良好,未见复发,l例患者在二期手术后24个月复发.结论 实性型成釉细胞瘤采用分期治疗法确切可行.     

Treatment outcomes of sinonasal adenoid cystic carcinoma: 30 cases from a single institution

ObjectiveTo establish the clinical features and prognostic factors of sinonasal adenoid cystic carcinoma (ACC).Material and methodsThirty patients with histopathological diagnosis of sinonasal ACC who were treated at Severance Hospital between 1990 and 2010 were included in this retrospective chart review study.ResultsThe 5-year disease-specific survival and disease-free survival rates were 75.3% and 37.2%, respectively. The maxillary sinus (63.3%) and nasal cavity (23.3%) were the most common sites of primary tumour. Most patients were diagnosed with advanced-stage (III/IV) disease (80.0%) and had undergone surgery and postoperative radiotherapy (70.0%). The most common histopathological subtype was cribriform type (40.9%). Local recurrence rate and distant metastasis rates were 26.7% and 23.3%, respectively. The mean time from primary treatment to recurrence was 44.5 months. Sinonasal ACC patients with stage IV and T4 disease had significantly worse survival than those with low stage and T disease. Patients with local recurrence had worse disease-specific survival than those with distant recurrence. Distant metastasis was associated with disease-free survival but not disease-specific survival.ConclusionDespite the frequent occurrence of distant metastasis, early diagnosis and effective local control seemed to be the most important factors influencing the survival of sinonasal ACC.     

Is there a role for enucleation in the management of ameloblastoma?

This study aimed to determine the appropriate long-term management for ameloblastoma and the role of enucleation in the management of the subtypes of ameloblastoma (solid ameloblastomas, cystic ameloblastomas and peripheral ameloblastomas). They differ in their degrees of aggressive behavior and recurrence rates. This is an evidence-based study with review of relevant articles from PubMed, EMBASE and the Cochrane Library. Articles were categorized for quality according to the Oxford Center of Evidence-Based Medicine (CEBM). 58 articles met the inclusion criteria; their evidence level varied from IIA to V. No randomized control trials were identified. Solid and multicystic ameloblastomas have a high recurrence rate (60–80%) with simple enucleation and require more aggressive treatment. The treatment of choice is resection with 1-cm margins. This may require segmental resection in the mandible, and partial maxillectomy in the maxilla. For the unicystic ameloblastoma recurrence rates are high for simple enucleation. The intraluminal subtype of unicystic ameloblastoma may do well with enucleation, but the intramural subtype may not, and since these cannot be identified preoperatively more aggressive treatment is recommended, including peripheral ostectomy or enucleation with subsequent treatment of the surrounding bone with liquid nitrogen, Carnoy's solution, or similar physicochemical modality. The peripheral ameloblastoma has a different origin and responds to local excision.     

Marginal and segmental mandibulectomy in patients with oral cancer: a statistical analysis of 106 cases.

PURPOSE: The treatment of oral squamous cell carcinoma may require mandibular resection to secure adequate margin. This bone resection often is segmental or marginal mandibulectomy. The purpose of this work was to evaluate the local control and survival after surgical treatment of oral cancer, according to these 2 different mandibular resection procedures. PATIENTS AND METHODS: We conducted a retrospective study of a 20-year cohort of 106 patients who underwent marginal or segmental mandibulectomy for oral cancer. All patients had a biopsy-confirmed diagnosis of squamous cell carcinoma involving either the floor of the mouth, mandibular gingiva, retromolar trigone, tongue, buccal mucosa, or oropharynx. The type of mandibular resection and treatment outcome were compared, using an univariate analysis by the Pearson chi(2) test, logistic regression model for multivariate analysis, and Kaplan-Meier method to determine survival. RESULTS: The 5-year observed survival rate was 60.35%. The presence of histologic mandibular invasion increased the local recurrence rate. Early tumor stages (P =.02) were found to be associated with decreased local recurrence rates. Our findings indicate that tumor stage and size of mandibulectomy are more important than the type of mandibulectomy in predicting histologic bone involvement. The cases treated with a greater than 4 cm bone resection showed a lower survival rate than those treated with less than 4 cm mandibulectomy (P =.01). Patients in advanced stages (P =.006) and those with surgical margin (P =.0001) or the bone (P =.003) affected by the tumor showed a statistically significant lower survival rate. However, no statistically significant differences were found between patients treated by marginal or segmental mandibulectomy. CONCLUSIONS: Among the prognostic factors studied, the status of the surgical resection margin, the bony involvement and the size of mandibulectomy affected the prognosis for oral carcinoma. Mandibular conservation surgery is oncologically safe for patients with squamous carcinoma in early stages. The marginal technique was not associated with worse prognosis.     

A modified surgical approach for the treatment of mandibular unicystic ameloblastoma in young patients

BackgroundUnicystic ameloblastoma is a distinct clinicopathological entity with its cyst-like radiographic appearance and occurrence in the mandible of young patients. Surgical resection of the mandible leads to jaw deformity and challenging reconstruction burden, especially among young patients. Conservative treatment, however, results in less serious function and esthetic impairment.PurposeWe aimed at evaluating dredging method as an alternative conservative surgical approach in young patient with large unicystic ameloblastoma.Patients and methodsTwenty patients (n=20) with histologically-diagnosed unicystic ameloblastoma were recruited for this prospective study. The surgical treatment protocol comprised an initial deflation (marsupialization) step, followed by later enucleation and subsequent repeated separate dredging procedures.ResultsThe study population comprised 16 males and 4 females. The average age at the time of diagnosis was 18.5 years. At the last follow-up period, achievement of normal mandibular bone contour with no radiographic signs of recurrence was evident.ConclusionThe dredging method as a modified surgical technique may represent a reliable approach for management of unicystic ameloblastoma in young patients.     

Histopathology of ameloblastoma of the jaws; some critical observations based on a 40 years single institution experience

The aim of the present study is to examine all cases of intraosseous benign ameloblastomas treated between 1970 and 2010 in a single institution and to look for a possible correlation between the histopathological aspects and the demographical and clinical parameters, as well as the treatment outcome. The data of a total number of 44 patients were retrieved from the records. Nine patients were excluded because of doubt about the correct diagnosis (8 patients) or because of an extra-osseous presentation (1 patient). No statistically significant differences were found between the histopathological (sub)types of ameloblastomas and the demographical and clinical parameters, nor between the histopathological (sub)types and treatment outcome. Of the 28 patients treated by enucleation, in 17 patients one or more recurrences occurred, with no significant predilection for any histopathological (sub)type, including the unicystic type. There were no significant differences in the recurrence rate after enucleation in patients below and above the age of 20 years either. In six out of 17 patients with a recurrence, the recurrent lesion showed a different histopathological subtype than was encountered in the primary. In two cases a change from solid/multicystic to desmoplastic ameloblastomas was noticed. In conclusion, the current histopathological classification of benign intraosseous ameloblastoma does not seem to have clinical relevance with the possible exception of the luminal unicystic ameloblastoma that has been removed in toto, unfragmented. Since no primary desmoplastic ameloblastomas were encountered in the present study no further comments can be made on this apparently rare entity.     

Ameloblastoma: current etiopathological concepts and management

Ameloblastoma is a benign odontogenic tumor of epithelial origin. It is locally aggressive with unlimited growth capacity and has a high potential for malignant transformation as well as metastasis. Ameloblastoma has no established preventive measures although majority of patients are between ages 30 and 60 years. Molecular and genetic factors that promote oncogenic transformation of odontogenic epithelium to ameloblastoma are strongly linked to dysregulation of multiple genes associated with mitogen‐activated protein kinase, sonic hedgehog, and WNT/β‐catenin signaling pathways. Treatment of ameloblastoma is focused on surgical resection with a wide margin of normal tissue because of its high propensity for locoregional invasion; but this is often associated with significant patient morbidity. The relatively high recurrence rate of ameloblastoma is influenced by the type of molecular etiological factors, the management approach, and how early the patient presents for treatment. It is expected that further elucidation of molecular factors that orchestrate pathogenesis and recurrence of ameloblastoma will lead to new diagnostic markers and targeted drug therapies for ameloblastoma.     

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??The ameloblastoma is a common type of odontogenic tumor within the jaw bone. The main clinical manifestation of the tumor is the non-painful expansive proliferation accompanied by local invasion. Currently??the major therapy method is surgery. However??the recurrence rate remains high after surgery. Thus??the repeated surgery is needed to treat the ameloblastoma completely??which results in great facial damage and brings about psychological dysfunction to patients. In recent years??researches have shown that multiple regulatory factors??target genes and the interaction between molecules are reported to participate in the proliferation and apoptosis of the tumor cells in ameloblastoma??which provide theoretical evidence for non-surgical treatment methods. This review will focus on the progress of signal pathway related to ameloblastoma.     

Risk factors for recurrence of ameloblastoma: a long-term follow-up retrospective study

Ameloblastoma is a benign odontogenic tumour showing locally aggressive characteristics. This retrospective study was performed to investigate the long-term treatment outcomes of ameloblastoma and to evaluate the risk factors for recurrence. The study was conducted in the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, the University of Hong Kong and covered the years 1990–2017. Patient demographic data, radiographic pattern and findings, clinical findings, tumour site and size, World Health Organization classification, treatment modality, histological pattern, duration of follow-up, and timing of recurrence were recorded and analyzed. The potential risk factors were analyzed by Kaplan–Meier and Cox regression tests. The cases of a total of 128 patients were reviewed; 65 were male and 63 were female. The mean follow-up period was 117 months. The 5-, 10-, and 15-year recurrence rates were 9.3%, 17.6%, and 24.4%, respectively. Kaplan–Meier and Cox regression tests showed that recurrence was significantly associated with radiographic pattern, tumour size, and treatment modality. Multiple regression analysis for these three variables demonstrated that treatment modality was the only independent prognostic factor for recurrence. This study showed that radical resection is the only significant factor for a low recurrence rate of ameloblastoma and patients require long-term follow-up for late-onset recurrence.     

刮除联合敞开术治疗颌骨经典型成釉细胞瘤的疗效观察

目的 探讨刮除联合敞开术治疗颌骨经典型成釉细胞瘤的可行性,为改进经典型成釉细胞瘤的治疗方法提供依据.方法 选取柳州市人民医院2016年至2019年收治的22例经典型成釉细胞瘤患者,采取刮除联合敞开术治疗,术后每月随访,复查曲面体层片面观察骨质恢复情况及有无复发.结果 22例患者术中均能完全刮除肿物,未发生病理性骨折,术...     

Ameloblastoma: a surgeon's dilemma.

PURPOSE: To investigate whether there were any significant differences in the mode of presentation, treatment, and outcome of patients presenting with a primary diagnosis of ameloblastoma in Glasgow, Scotland and San Francisco, CA. MATERIALS AND METHODS: All cases of ameloblastoma seen in both institutions between January 1, 1980 and December 31, 1999 were included in this study. Mode of presentation, radiographic appearance, histologic appearance, treatment, and follow-up were recorded. RESULTS: There were no significant differences in the clinical features on presentation (swelling, followed by pain, and altered sensation), the radiographic appearance (unilocular approximately 30% and multilocular 70%), or management with either local treatment (enucleation and/or curettage in just over 50% of cases) or radical treatment (a form of resection in under 50%) in the 50 cases included in this study. Primary care by conservative treatment led to a recurrence in approximately 80% of cases and this included cases of unicystic ameloblastoma. CONCLUSION: The mode of presentation, diagnosis, and management of the ameloblastoma was remarkably similar in Glasgow and San Francisco. The recurrence rate following local enucleation and curettage was unacceptably high, and this included the cases of unicystic ameloblastoma, which should be treated more aggressively than has been recommended in the past.