What kind of tumor is this and how does it grow?
The source of the tumor is epithelial cells remaining in the jaw after the formation of tooth germs. They begin to grow, forming cavities and cords that gradually push the bone tissue apart. The most common form is multi-chamber, giving a characteristic picture of soap bubbles in the image. Less common is the unilocular variant, especially in young patients, which can easily be mistaken for a regular cyst. The tumor grows very slowly, over the years, so the body has time to adapt and there are no complaints for a long time. In approximately the majority of cases, the lower jaw is affected, most often in the area of the wisdom teeth.
- Source - remains of tooth-forming epithelium
- Most often affects the lower jaw
- The multi-chamber form gives a picture of soap bubbles
- Single-chamber variant looks like a cyst
- Grows for years, does not metastasize
- Destroys bone from the inside
Symptoms
The most common first sign is a gradual painless increase in the volume of the jaw, which a person notices due to a change in the contour of the face or because a denture no longer fits. Teeth in the area of the tumor may shift, diverge and become mobile, although the gums are healthy. When the bone thins, pressure causes a feeling of yielding and a slight crunch. If the tumor compresses the inferior alveolar nerve, the lower lip and chin become numb. Pain appears late, usually due to inflammation or fracture of a thinned bone.
- Painless swelling of the jaw
- Facial asymmetry
- Tooth displacement and mobility
- Numbness of the lower lip and chin
- Difficulty opening the mouth
- Pathological fracture of the jaw
Diagnostics
The first study is usually a panoramic or targeted photograph of the jaw, which shows bone loss with clear boundaries, sometimes with septa. To plan the operation, computed tomography is required: it shows the true boundaries of the tumor, the condition of the outer and inner bone plates, and the relationship to the mandibular nerve canal. The final diagnosis is made only by the result of a biopsy with histological examination, since in the image ameloblastoma can easily be confused with a cyst and other tumors. The material must be re-examined after removal.
- Panoramic or targeted shot of the jaw
- Computed tomography of the facial skeleton
- Biopsy with histological examination
- Assessing the relationship to the mandibular canal
- Re-examination of removed material
- Consultation with an oncologist if in doubt
Treatment
The main principle is to remove the tumor with a supply of healthy tissue. Simply scraping out the cavity, as with a normal cyst, often causes the disease to return in ameloblastoma because individual cells invade the surrounding bone. Therefore, resection of the affected area of the jaw is usually performed within healthy tissue. Gentle techniques are sometimes used for the single-chamber form in young patients, but only with careful observation. At the same time or delayed, the jaw is restored with a bone graft or structure, and then dental prosthetics is performed. Treatment is carried out by an oral and maxillofacial surgeon.
- Resection of the jaw within healthy tissue
- Gentle techniques only for certain forms
- Immediate or delayed bone restoration
- Preservation of the mandibular nerve whenever possible
- Dental prosthetics after healing
- Treatment in a specialized department
Observation and forecast
Ameloblastoma can return even many years after surgery, so long-term observation is necessary - with control images according to a schedule set by the surgeon, usually over many years. It is important for the patient to report any new swelling, numbness, or changes in bite to the doctor without waiting for a scheduled appointment. With radical removal, the prognosis is good, and modern reconstruction methods make it possible to restore both appearance and chewing. The most important thing is not to delay treatment: the smaller the tumor, the smaller the scope of the operation and the easier the recovery.
- Long-term observation with control images
- Immediate visit for new symptoms
- Rehabilitation of chewing function
- Prosthetics and aesthetic restoration
- The prognosis is good with radical surgery
