Odontogenic Tumors
Ameloblastoma
Benign but locally aggressive odontogenic epithelial tumour; the most common clinically significant odontogenic tumour.
§ overviewOverview
A slow-growing, locally invasive epithelial odontogenic neoplasm derived from odontogenic epithelium.
§ epidemiologyEpidemiology
20–50 years; posterior mandible 80%. Equal sex distribution.
§ pathogenesisPathogenesis
BRAF V600E mutation in ~60% of conventional ameloblastomas.
§ clinicalClinical Features
- 01Painless bony expansion — 'egg-shell crackling'
- 02Displaced teeth, root resorption
- 03Facial asymmetry
§ histopathHistopathology
- 01Follicular: islands of odontogenic epithelium with peripheral palisaded columnar cells (reverse polarity, Vickers–Gorlin criteria) and stellate reticulum-like centre
- 02Plexiform: anastomosing strands of odontogenic epithelium
- 03Other patterns: acanthomatous, granular cell, basal, desmoplastic
§ radiographicRadiographic Features
- 01Multilocular 'soap-bubble' or 'honeycomb' radiolucency
- 02Buccolingual expansion, thinned cortex
- 03Root resorption, tooth displacement
§ cbctCBCT Findings
- 01Cortical perforation, buccolingual expansion, IAN canal relation
§ ctCT Findings
- 01Bony destruction, soft-tissue extension in aggressive lesions
§ mriMRI Findings
- 01Solid + cystic components; contrast-enhancing mural nodules in unicystic
§ classificationClassification
- 01Conventional (solid/multicystic)
- 02Unicystic
- 03Peripheral (extraosseous)
- 04Metastasising (malignant behaviour with benign histology)
§ treatmentTreatment
- 01Conventional: segmental/marginal resection with 1–1.5 cm bony margins + immediate reconstruction
- 02Unicystic (luminal/intraluminal): enucleation ± Carnoy's
- 03Mural unicystic: resection
- 04Peripheral: local excision
§ surgicalSurgical Management
- 01Resection with reconstruction plate + fibula free flap
- 02Enucleation + peripheral ostectomy for select lesions
§ complicationsComplications
- 01Recurrence (curettage 50–90%, resection 10–15%)
- 02Malignant transformation to ameloblastic carcinoma
§ prognosisPrognosis
Excellent local control after resection; long-term follow-up 10+ years.
§ vivaBDS Viva Questions
- 01Vickers and Gorlin criteria for ameloblastoma diagnosis?
- 02Compare enucleation and resection outcomes.
§ pearlsClinical Pearls
- 01'Soap-bubble' + 'knife-edge' root resorption + BRAF V600E = ameloblastoma.
§ mnemonicsMnemonics
- 01A-B-C-D: Aggressive, Benign histology, Cystic-solid, Deforming
§ mcqsMCQs — Assessment (1)
Question 1
Most common site of ameloblastoma:
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.