Table of Contents
Introduction
Ameloblastoma jaw tumors, although benign, can be very aggressive and cause harm if they are not treated. These tumors, arising from epithelial cells, are some of the most common dental pathologies encountered by oral and maxillofacial surgeons. In the beginning, they seldom metastasize, if left untreated ameloblastomas can become locally invasive, which in turn results in serious problems. These tumors can cause midface defects, impair the soft tissue spaces, and even reach the paranasal sinuses. Recognizing the viable impacts and significance of the treatment within the proper time limits are the primary factors for stopping the outlined complications.
What Happens to Untreated Ameloblastoma Tumors of the Jaw?
Almost a massive fourteen percent of oral or jaw tumors and cysts are represented in oral pathologic and medical literature by the benign and aggressive tumors of ameloblastoma. These are basically the tumors arising from epithelial cell origins that are also the most frequently documented and encountered cases in dental pathologies by oral and maxillofacial surgeons. It is interesting to note a peculiar feature of this benign tumor (non cancerous local tumor) that it affects individuals in between the third and fourth decade in life. There are many histopathological variants of this benign jaw tumor of which the major variants are the solid or multicystic jaw ameloblastomas (the conventional form of tumor) and the second reportedly frequent variant is the unicystic form of ameloblastoma.
The main management strategy for treating these benign and aggressive jaw tumors is through surgical resection only. Why would these benign tumors turn aggressive when left untreated? Even though these tumors have limited potential for metastasis in their initial benign pathologic variants, when left in chronic stages or in their untreated aspect, they can undergo malignant or cancerous transformation. They can also be locally invasive into the soft tissue of the jaw, that is in the neck regions and affect the lymphatics.
What Are the Complications, and How Is Common Ameloblastoma Managed?
One of the major complications that can occur with untreated and chronic ameloblastoma lesions in the jaw are there they can hold potential to cause mid face defects or impair the soft tissue spaces and the paranasal sinuses as well. In moderate to severe lesions of the mandible, surgical resection and jaw reconstructive surgery with autologous bone grafts or fillers is the method post operatively to restore jaw esthetics and functions.
But there are a number of complex challenges that are to be dealt with upper jaw tumors or maxillary ameloblastomas. Explore these surgical strategies and remedies in detail below .
How Are Maxillary Ameloblastomas Approached?
Though maxillary or upper jaw ameloblastoma is much more of a rare occurrence in comparison to lower jaw or mandibular ameloblastoma, the oral and maxillofacial functions and esthetics of the mid face can be extremely impaired with the sides of these unique and complex lesions. Further because of the high frequency of jaw recurrence of maxillary ameloblastoma, which has a global incidence of 25 percent as per global statistics, there is a need for managing the upper jaw or maxillary ameloblastomas through innovative surgical approaches that would not interfere with the patients functionality or esthetics.
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Firstly, in maxillary ameloblastomas a thorough preoperative evaluation would be performed by the maxillofacial surgeon in assessing the extent of lesions. After conservative surgical excision and careful border analysis or extent of the tumor lesions, with the assessment of both facial symmetry and visual functions, the surgeon goes ahead with the maxillectomy surgery.
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Dental researchers or authors usually recommend tumor excision of around 10 to 20 mm beyond the limits observed radiologically of the ameloblastoma lesions. This is because the lesion would be further extending by 0.8 to12 mm almost beyond the radiologic limits as well ,according to surgical research.
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Surgical approaches in maxillectomy basically involve the resection of osseous tissue that would be involving invariably parts of the alveolar ridge, the sinus walls (of maxillary sinus), hard palate or even the floor of the orbit, depending on the extent of the maxillary tumor. Conservatively, the surgeon would spare some amount of tumor that would be overlying upon the superficial epithelium or skin tissues.
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Surgical closure of the wound is achieved with effective hemostasis. As mentioned earlier , the tumor that would be overlying the skin tissue or the superficial epithelium of the face or jaw would be retained and enable closure of margins. The oral surgeon aims to sustain both the facial morphology and achieve satisfactory oral and maxillofacial functions for the patients rehabilitation.
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There are two main types of classified defects based upon the tumor extent and their origin as well as spread in the maxillary regions. In type1 and 2A defects of maxillectomy classified by surgeons, closure of the surgical wound is done by using the superficial retained skin and conservative margin maintenance as mentioned earlier. In extensive defects that is type 3 maxillectomy defects, because the maxillofacial regions are severely affected by the invasiveness of the tumor, there is a need for the maxillofacial surgeon to reconstruct several important regions like the tumor involved areas (such as the hard palate ,the orbital floor ,the cheek, and maxillary arch).
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Reconstructive surgery of these parts is extremely pivotal and plays a major role in sustaining patients' facial symmetry, form, and functions. Further esthetics is a major factor to be considered by surgeons because extensive defects can make the quality of life compromised for affected patients. Hence the need for the challenging procedure of maxillectomy and reconstructive surgery to deal with these defects induced by the tumor in the midface region .
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For reconstructive surgery of type 3 maxillectomy defects, vascularized bone containing grafts from the scapula or the collar bone, the tibia, or others tibial bones are considered. The grafts or tissue transfer from iliac crest of the patient and forearm are also surgical considerations for reconstructive surgery. These are new age modalities in maxillofacial surgery now compared to the traditional use of non-vascularized bone grafts or tissue transfers.
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Oral functions such as mastication post dental or jaw rehabilitation, that is ability to chew food satisfactorily or if the patient is facing disturbances in chewing food or difficulty in opening their mouth even post operatively should be considered and antibiotic prophylaxis instituted accordingly.
Conclusion
Maxillectomy is the choice of surgery with conservative therapies holding great surgical value. However, both the recurrence and the aggressiveness of local benign tumors of ameloblastoma are extremely high, with the maxillary unique and rare tumors poising immense surgical challenges to the maxillofacial surgeon. Radical surgery with postoperative reconstructive surgeries and follow ups to improve the patients quality of life by tracking their esthetics, form, and function, becomes imperative.
