I - Benign

Epithelial Odontogenic tumours

Ameloblastoma :
Benign aggressive tumor that is invasive and persistant sometimes
called solid or multicystic ameloblastoma.
- It is the most common neoplasm of the jaws.
Clinical features :
Age : Between 3rd to 5th decades.
Sex: No sex predilection
Site : Mandible more than maxilla 80% of cases were in mandible . In the
mandible 70% of cases were in molar ramous region.
Note: The trigger or stimuls for neoplastic transformation of these residues
is unknown
Characters :
- Asymptomatic
- Slowly growing
- Discovered by X ray
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Radiographic Appearances :
1) Multilocular radiolucent area.( Honey comb pattern) & expanded lingually
2) Unilocular radiolucent area usually associated with impacted tooth ( as in dentigerous cyst.

Microscopic appearances:
-Different histological patterns are seen under microscope.
-The epithelium forming this neoplasm resembles that epithelium which forms the enamel
organ.
- The fibrous stroma surrounding this epithelium vary in both quantity & cellularity ( not
neoplastic one).
- In most cases the stroma is collagenous with few cells while in other cases , the stroma may
be abundantly cellular .

Macroscopic appearances :
- Solid or cystic or both together.
- Traversed by bony ridges.
Two main histological patterns are commonly seen in
ameloblastoma.
1- Follicular
2- Plexiform.
Follicular Ameloblastoma: In this patterns , the odontogenic
epithelium takes the form of discrete islands separated from each
other by variable C.T. stroma ( non - neoplastic C.T.).

Plexiform Ameloblastoma :
- In this variant , the tumour epithelium is arranged in the form of
irregular intercommunicating anastomosing strands but not in the
form of discrete islands as in follicular variant.
I) The arrangement of cells of these strands is the same as that of
follicular .

Diagnosis of Ab :
1- biopsy for histological examination.
2- X- Ray .
3- Magnetic resonance ( solid or cystic types).
Treatment : N.B: no single standard type of therapy can advocated
for patients with Ab.
1- Surgical removal with safety margins.
2- Large tumours may require bony resection or even the whole
jaw.
3- Ab. radioresistent tumour so it is not treated by radiotherapy.
Prognosis :
1- Solid & multicystic have a higher tendency to recur when treated
conservatively ( i.e. without safety margin )
2- Maxillary Ab when allowed to reach a large size may give rise to
serious complication .
3- Adequate treatment gives good prognosis.
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