Recurrent ameloblastoma of the anterior skull base: Three cases treated by radical resections

doi:10.1016/j.jcms.2006.06.001

Journal of Cranio-Maxillofacial Surgery

Volume 34, Issue 7, October 2006, Pages 412-414

https://doi.org/10.1016/j.jcms.2006.06.001 Get rights and content

Summary

Introduction

Recurrent ameloblastomas rarely present in the anterior skull base but are, common following inadequate excision.

Patients and methods

Three patients are presented with ameloblastoma in the anterior skull base including frontotemporal fossa and pterygomaxillary fossa recurring following multiple enucleations, segmental mandibulectomy, or partial maxillectomy. The recurrences were found 3–4 years following the primary operations. All 3 patients were treated by radical dissection.

Results

Microscopically one case was a mixed follicular and plexiform, two cases were of a follicular type. All patients healed without serious complications.

Conclusion

Ameloblastomas in these regions have a greater recurrence potential even when treated by radical dissection.

Introduction

Ameloblastoma is a benign but locally invasive epithelial odontogenic tumour. Recurrence is most common after inadequate treatment, with an incidence of up to 90% in the mandible and 100% in the maxilla (Sehdev et al., 1974). In cases of radical resection including adjacent soft tissues, a recurrence rate of 5–15% has been reported (Muller and Slootweg, 1985). A few cases of recurrence have been reported involving the temporal fossa (Hayward, 1991; Demeulemeester et al., 1988; To et al., 2002). In this paper, 3 patients are presented with recurrent ameloblastomas in the anterior skull base (frontotemporal fossa or pterygomaxillary fossa) each of which was treated by radical resection.

Section snippets

Patient 1

In 1997, a 42-year-old woman with right frontotemporal swelling was referred. The patient had a right mandibular ameloblastoma treated by currettage at the ages of 26 and 32, and then a segmental mandibulectomy at the age of 37. Physical examination showed a 5×8 cm hard, well defined mass with right exophthalmos (Fig. 1A). CT scanning showed a large multilocular lesion in the right pterygomaxillary fossa and the skull base involving the orbital region (Figs. 1B,C). The patient underwent removal

Discussion

The problem of recurrence following removal of an ameloblastoma can be attributed to inadequate excision and the spread of residual tumour fragments within adjacent bone (To et al., 2002). In the 3 patients reported, recurrent ameloblastomas spread to the frontotemporal, infratemporal and pterygomaxillary fossae, orbit, and skull base. The ages of the three patients at the time of the first operations were 17, 26, and 38 years respectively (mean 27 years). Two of the primary tumours were

References (10)

HF. Al-Bayaty et al.
Soft tissue recurrence of a mandibular ameloblastoma causing facial deformity in the temporal region: case report
J Oral Maxillofac Surg
(2002)
LJ. Demeulemeester et al.
Late loco-recurrences after radical resection for mandibular ameloblastoma
Int J Oral Maxillofac Surg
(1988)
XC. Jian et al.
A new surgical approach to extensive tumours in the pterygomaxillary fossa and the skull base
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2003)
H. Muller et al.
The ameloblastoma, the controversial approach to therapy
J Max Fac Surg
(1985)
NR. Attenborough
Maxillectomy via a temporal approach (a new technique )
J Laryngol Otol
(1980)

There are more references available in the full text version of this article.

Cited by (16)

Peripheral ameloblastoma presenting as a solid mass in the temporal fossa: A case report and review of the literature
2022, Oral and Maxillofacial Surgery Cases
Citation Excerpt :
The possible mechanism of spread could be explained by the inadequate excision of the tumor and the implantation of tumor cells within adjacent bone. Ameloblastoma cells in these locations may remain in the temporal muscle attachments at the coronoid process after retraction and detachment, and later, via infiltration along the fibers of the temporal muscle, contribute to recurrence in the temporal region as well as within the muscle [18,19]. Since there were no records of a previous tumor and our patient denied surgical history of tumor removal from the mandible, recurrence was deemed unlikely.
Ameloblastoma is a rare epithelial odontogenic tumor of the oral cavity, representing only 1% of all oral tumors. Despite being a benign neoplasm, ameloblastomas are slow-growing, locally aggressive tumors that may infiltrate adjacent tissues, causing extensive tissue destruction. It usually presents as an asymptomatic swelling in the posterior region of the mandible. Ameloblastoma in non-tooth-bearing areas is very rare.
We present a case of peripheral ameloblastoma (PA) appearing as a solid mass in the temporal fossa. The lesion was initially diagnosed as a cystic lesion and hematoma, but further treatment with complete removal and histopathological analysis led to the diagnosis of PA.
Brain ameloblastoma: metastasis or local extension case report and physipathological reflexion
2018, Journal of Stomatology, Oral and Maxillofacial Surgery
Ameloblastoma is a rare benign odontogenic tumor with a metastasis rate estimated at 2% of cases, mainly involving the lung (80%) and lymph nodes (20%).
We hereby present the case of a 26 year old patient with a history of locally recurrent mandibular ameloblastoma who developed a temporal intracranial ameloblastoma tumor requiring a collaborative neurosurgical and maxillo-facial radical surgical approach.
Although ameloblastomas are histologically benign, the temporal topography questions the dissemination pathophysiology of the tumor (metastasis or local extension through temporal muscle fibers), mainly relevant in cases of multiple recurrences.
Cranial surgery without head shaving
2009, Journal of Cranio-Maxillofacial Surgery
Citation Excerpt :
Patients scheduled for cranial surgery usually undergo total or partial shaving of the scalp hair because its presence has been thought to contribute to postoperative wound infection (Chen et al., 2006; Kinnunen and Aitasalo, 2006; Scholz et al., 2007; Greene et al., 2008; Plooij et al., 2008).
Based on a series of 632 patients who underwent craniotomy without head shaving, we report the efficacy and safety of our simplified procedure and document the usefulness of the electrosurgical scalpel.
After brushing a chlorhexidine–alcohol solution onto the craniotomy site, the hair was parted from the incision line and fixed with adhesive paper drapes. In recent cases, electrosurgical scalpels were used for scalp- and subcutaneous dissection. At the end of surgery, the wound was closed in the usual manner, taking care that no hair was in the wound and the hair and wound were rinsed with clean water in the operating room. We did not apply disinfectant for postoperative wound care, rather, the hair was shampooed on the 2nd, 4th, and 6th postoperative day.
Among 632 patients who underwent cranial surgery without head shaving, only 7 (1.1%) developed postoperative wound infections. None of the 34 patients who underwent craniotomy using the electrosurgical scalpel developed wound infections.
Our simplified cranial surgery without head shaving does not increase the risk of wound infection. Because the use of the electrosurgical scalpel for skin and soft tissue dissection minimizes bleeding, the probability of wound infection appears to be reduced.
Simultaneous occurrence of facial fibrous dysplasia and ameloblastoma
2009, Journal of Cranio-Maxillofacial Surgery
Citation Excerpt :
The mainstay of treatment is surgery, which varies from conservative treatment, such as enucleation and/or curettage, to wide resection. Although the extent of resection is controversial, wide resection with 1–1.5 cm bony margins results in the highest likelihood of local control (Chen et al., 2006). Unlike FD, other primary tumours rarely occur with or arise from ameloblastoma.
Both fibrous dysplasia (FD) and ameloblastoma are benign but locally aggressive tumours of the craniofacial region. In this case report, we present the unique synchronous occurrence of these two tumours in the facial skeleton.
A 16-year-old woman presented with complaints of swelling of the upper right face and at the inferior border of the mandible. She was diagnosed as FD of the maxilla, temporal bone and sphenoid sinus together with ameloblastoma of the mandible after surgery and histopathological evaluation.
The case that we present here is unique in that two separate pathological conditions, FD of the upper face, and ameloblastoma of the mandible coexisted. Although cases of synchronous or metachronous occurrence of FD and ameloblastoma with other pathology have been previously described, this to our knowledge, is the first reported case of true coexistence of FD and ameloblastoma.
Benign Tumors/Premalignant Conditions
2023, Medical Radiology
Ameloblastoma and Intracranial Involvement: The Current Challenge of the Radical Surgical Treatment. Comprehensive Review of the Literature and Institution experience
2022, Journal of Maxillofacial and Oral Surgery

View all citing articles on Scopus

View full text

Case ReportRecurrent ameloblastoma of the anterior skull base: Three cases treated by radical resections

Summary

Introduction

Patients and methods

Results

Conclusion

Introduction

Section snippets

Patient 1

Discussion

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Max Fac Surg

Maxillectomy via a temporal approach (a new technique )

J Laryngol Otol

Case Report
Recurrent ameloblastoma of the anterior skull base: Three cases treated by radical resections