I am an Orthopaedic Spine Surgeon...A carpenter of the body. I've missed work a total of 3 days in the last fifteen years of practice due to illness. In 6 years of residency and fellowship I missed only 4 days after having ACL reconstruction. I never get sick!

My stellar attendance record is about to change.

Recently, I have been diagnosed with Ameloblastoma...an uncommon, benign yet aggressive tumor of my jaw.

I am not a wordsmith, but I have been inspired by the few others out there who have blogged about their experiences with ameloblastoma. I look at it from a clinical perspective as a surgeon (While the diagnosis is foreign to me, the surgical management and treatments are very familiar to me.) and scientist, I am also the patient. A rare perspective that I thought by sharing, I could enlighten others with both clinical information, and personal experience.


Saturday, December 1, 2012

ameloblastoma (ām'ə-lō-blā-stō'mə)

I am now about 4 weeks into the process. A week between tender teeth time and my dental exam. A couple of days for the endodontist. Another day til I saw Dr. W. Antibiotics and CT took another week. Biopsy and then follow up about 10 days later. And.....

The verdict is in. Last Friday night Dr. W called to tell me the news of my pathology report. "The good news is it's not cancer." Good. "The not so good news is that it is an ameloblastoma. It's benign but will need surgery. You will lose some teeth, but it will be okay" Yeesh

http://www.ajronline.org/content/197/3/W412/F4.small.gif
This is the picture that scared me a little
In all my reading before the biopsy, the one picture that stood out was the surgical specimen from resection of an ameloblastoma.  Teeth, jaw etc. sitting on a surgical towel waiting to go to pathology. Jeez I hope that isn't what I have, I had thought.  My surgeon brain then went into overdrive regarding how one puts it back together.  You would need some sort of bone graft...Iliac crest? Fibula? Rib? A plate to fix the bones would be needed. How long til it was healed? Would it look "normal" once all put back together?

Nahh, it couldn't be that I had thought.


Medium Power View
Low Power View
Medium Power View

 AMELOBLASTOMA!!!


Well, indeed it is ameloblastoma. This is an uncommon (although the most common odontogenic tumor seen in the jaw. Approximately 50% of odontogenic tumors), benign tumor that is known to be aggressive and will come back in 50-90% of cases if not fully removed. It actually comes from the cells from where the teeth originate from and it is what creates the enamel. Essentially normal cells gone wild. There are several types of ameloblastoma including:

  • Conventional/Solid or Multicystic (This is what I have)
    • 3rd - 5th decades of life
    • Located in the mandible in 85%, mostly posterior
    • Lesion is peri-apical (nearby to the tips of the roots of the teeth)
      • Follicular - 28% of conventional type
        • Islands of epithelial rests in stroma
      • Plexiform - 32% of conventional type
        • Strands and cords
      • Acanthomatous  - 12% of conventional type
        • Squamous metaplasia
  • Unicystic
    • 1st - 3rd decades of life
    • 5-22% of ameloblastomas 
    • Male:Female = 1.6:1
    • Often associated with impacted teeth
    • Lined with epithelium
    • Possible to treat with curettage alone in some cases
  • Desmoplastic
    • 3rd - 7th decades of life
    • 4-13% of ameloblastomas
    • Often involves the maxilla and the anterior mandible
    • Compressed islands and thin cords
  • Maxillary
    • Most feared type due to proximity to skull, orbits and intracranial structures
    • Males=Females
    • Sinus extension in men is 10.6%, in women is 5.9%
    • Radical surgery is mandatory
Here are some references and reviews about ameloblastoma types.

Okay, so I have ameloblastoma. I would have to say I was surprised, somewhat shocked and a bit anxious. What about treatment? The literature I reviewed, the case reports, and even the blogs out there all pointed to the need for resection of the tumor with a border of normal bone of about 1 cm on all sides. How much bone is removed depends especially on the location of the tumor. Those tumors growing in the back part of the jaw tended to get larger and needed bigger resections. Remember that photo (above) that scared me? That is a resection of the back part of the jaw including the part where the jaw attaches to the skull. Good, mine is both fairly small and in the front. 

Jargon Alert:
resect /re·sect/ (-sekt´) to excise part or all of an organ or other structure

Well....It's time to talk to the guy who will take care of my little friend. I am fortunate to live where I do in that there are some very good maxillofacial surgeons right here. Dr. W recommended that I see Dr. M at Vanderbilt. Not only the chairman of the department, but also his mentor in training. Having done my residency at the same time as Dr. W, I know about Dr. M and feel very comfortable with that recommendation.

Lucky me, he had an available appointment in just a couple of days. Honey, I've got myself a doctor's appointment.

Off to Vanderbilt....
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