Management of ameloblastomas in Africa

Ameloblastoma is the commonest odontogenic tumour that occurs more often in the mandible as compared to the maxilla. Because of its infiltrative behaviour, ameloblastoma, when treated by conservative approach has a high recurrence rate. Treatment, therefore, require a marginal or segmental resection with a 1.5–2.0 cm tumour-free margin as seen on the radiographs. Since patients in this part of the world often present with rather big tumours, such treatment leave the patients with large defects that need reconstruction otherwise they become dental cripples.

Selected patients were enrolled for treatment using a reconstruction technique using autogenous particulated cancellous bone mixed with autogenous PRP and activated with calcium chloride and thrombin. A cortico-cancellous bone grafts were harvested from the anterior iliac crest. The size of this piece of bone was estimated according to the defect created by the resected tumour. With the teeth in occlusion, two pre-shaped 2.3 mm titanium plates (Smart-Plates) were fixed in proper position using screws. The mixture of autogenous particulated cancellous bone and autogenous PRP was placed in the gap to replace the lost bone. The wound was then sutured and the patient put on antibiotics. Intermaxillary fixation was used, when possible, and the patients were fed using a naso-gastric tube for at least ten days. A quality of life assessment (QOL) was done before and after treatment.

Over the past nine years, 40 patients, 14 males and 26 females with an average age of 26.5 years were treated using this method. Consecutive follow up X rays showed good bone formation in the vast majority of these patients. There were only few complications and the QOL showed that almost all of them had a much better QOL after as compared to before treatment. The main advantages of this method were that it is done in one surgical session and therefore the patients did not have to go back to hospital for a second operation.

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Jan 27, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Management of ameloblastomas in Africa
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