A FIFTY THREE YEARS OLD WOMAN WITH RIGHT

MANDIBULAR AMELOBLASTOMA

By:
Astridia Maharani Putri Dewanto G99142119
Arafi Afra Linda Pangestika G99142122

Supervisor : dr. Amru Sungkar, Sp. B, Sp.BP-RE (K)

Periode : 21 November – 26 November 2016

Patient Status
 Name : Mrs. J

 Age : 53 years old

 Sex : Female

 Address : Madiun

 Religion : Islam

 No. RM : 01351558

 Date of admission : 20 November 2016

CHIEF COMPLAINT

Lump at the right jaw

 CURRENT HISTORY

Patient come to the hospital with complaint a lump at her

right jaw that become bigger. She felt the lump grow
since 10 years ago. She told that the lump appeared after
her tooth was extracted. At the beginning, the lump just
as big as a marbel, but gradually enlarged. Until in 2014,
she visited the doctor and did a biopsy examination in
Caruban Hospital, Madiun. After that examination, she
felt that the lump was getting smaller. But in this 2 years,
the patient feels that the lump is getting enlarge again.
After that, she referred to RS Dr Moewardi Surakarta.
PREVIOUS HISTORY FAMILY HISTORY

Trauma history (-) Same complaint (-)

Same complaint (-)

Other malignancies (-)

 LOCAL STATUS
Right Mandible Regio
 Inspection : lump (+) sized 10x7x5 cm

 Palpation : solid consistency, not mobile, tenderness (+) at

mandibular body
LOCAL STATUS
 ASSESMENT I

Tumor of the Right Mandible

 PLANNING I

1. Skull AP/Lat X-Ray

2. Panoramic X-Ray
 Biopsy Examination

Result : Ameloblastoma
Skull AP/Lat X-Ray
Result :
- Destruction of
mandible
- Leads to tumor
of the right
mandible
Panoramic X-Ray
Result : leads to
ameloblastoma
 Assesment II

 Right mandibular ameloblastoma

 Planning II

Pro reconstruction hemimandibulectomy

TINJAUAN PUSTAKA
AMELOBLASTOMA
Definition

Ameloblastoma is a
More frequent at
tumor that come Mostly benign, but
mandible than
from undifferentiated locally invasive.
maxilla
enamel.
 Prevalence

- Most frequent site of the tumor : 85% → mandible; 15% → maxilla

- Common in adult, aged about 20-50 years old
Etiology
Remain unclear, but some
hypothesize that ameloblastoma
could happen after :
• Extractions
• removal of cysts and or
• local irritation in the mouth
Pathophysiology: the tumor could came from
The rest of the cells of the enamel organ or the remnants of the dental lamina

Remnants of epithelial Malassez or leftover wrapping Hertwig contained in

periondontal ligaments teeth that will eruption
The epithelium of odontogenic cyst, especially dentigerous cyst and odontoma

Basal epithelial cells from the surface of the jaw bone

Impaired development of enamel organ

Heterotropik epithelium in other parts of the body, particularly the pituitary

gland
Clinical Presentation
 Asymptomatic (at the very beginning)
 Gradually enlarged lump (in years), sometimes
pain at the local site
 Deformity of the face
 After years, the lesion is followed by ulcers and
enlargement of periodontal tissue
 Destruction to mandible bone
Clinical Presentation

Intraoral ameloblastoma

Extra oral ameloblastoma

Classification

A : Solid/multicyst type
B : Unicyst type
C : Peripheral type
Classification: solid/multicyst type
• Symptoms found
when the lump is
getting bigger and
bigger gradually
• Varies in histological
examination :
follicular, plexiform,
granular
• Prevalence of
recurrency is high
Classification: unicyst type

• Mostly found in young adult aged 20-30 years old

• Formed in dentigerous cyst clinically or
radiologically
• Conservative surgical treatment such as curettage
has been used to treat ameloblastoma unikistik
Classification: peripheral type

• usually appears as a
hard nodule stemmed
the gingiva or alveolar
mucosa, measuring
0.5 to 2 cm, without
ulceration and pain.
Classification: histopathology

Follicular type Plexiform type

Classification: histopathology

Acanthomatous type Granular cell type Basal cell type

Radiology
Dental x-ray
• Panoramic
• Periapical and oclusal
• PA, lateral, and submento vertex

CT Scan
• Could detect perforation of the cortex and
tumor invasion to surrounding soft tissue
MRI
Differential Diagnosis
Dentigerous cyst

odontogenic keratosis

Giant cell carcinoma

Odontogenic myxoma

Ossifying fibroma
Therapy
Invasive therapy of ameloblastoma was
divided into 3 steps:
1.Tumor excision
2.Reconstruction
3.Rehabilitation
Therapy: tumor excision
enucleation
• the removal of the tumor by eroding the surrounding normal tissue

cryosurgry
• Exposure to extreme cold temperatures to the selected tissue using tools consisted of
nitrogen liquid

Block excision
• Excising tumor and some of its surrounding bone.

Peripheral osteotomy

Cauterization

Tumor resection
• Total resection and segmental resection (hemimaxillectomy and hemimandibulectomy)
Therapy: reconstruction

Fibula flap

Internal distraction
osteogenesis

Bioimplant BMP-7
Therapy: reconstruction

Titanium Reconstruction Plat

Prognosis
 Ameloblastoma have high recurrency rate after
therapy,
 23% in ameloblastome multicyst type
 14% in ameloblastome unicyst type
Thank you