Daniel Atieh Odontomes and Odontogenic Tumors Task 5

1) Compare and contrast odontomes and odontogenic tumors?

*I will consider what is clinically more important. From odontomes, I will relate to complex and compound odontomes
and with odontogenic tumors I will relate to ameloblastoma.

odontomes odontognic tumor

- true neoplasm,
- Not a true - both does not
neoplasm, regarded metastasise - appears at older
as hamartoma ages
- both can appear in
- appears at young ages posterior mandible
- recurrence
region
potential
- No recurrence
- both usually
painless - worse prognosis
- good prognosis

- treated by enucleation - treated by excision

along with normal
tissue

2) Describe the clinical presentation of odontomes and odontogenic tumors?

Patients with odontomes will come to the clinic complaining of a missing tooth. There is usually no pain or enlargement
seen. More commonly, it affects the maxilla more than the mandible and patients are usually young in age. While a patient
with odontogenic tumor will be an adult patient presenting usually with facial deformity complaining of a swelling that is
painless and usually in the molar region of the mandible. The lesion does not show signs of malignancy like rapid
enlargement or ulceration etc. In advanced stages, it can produce a diagnostic sign of egg-shell crackling when palpated
due to the thin shell of bone produced.

3) When to suspect and how to confirm the diagnosis of unicystic ameloblastoma?

I will suspect unicystic ameloblastoma when a young patient (usually 16-25 years old) presents with a painless localised
swelling in the mandibular molar region specially when associated with impacted tooth (presentation can also be due to
impacted tooth alone).

Confirming diagnosis is done by histopathology (multiple sections required).

4) Compare the prognosis of unicystic ameloblastoma to that of simple dental cysts?

Unicystic ameloblastoma Simple dental cyst

Prognosis is less predictable as it may show recurrence in Usually unicystic ameloblastoma appears identical to
the mural variant when treated with enucleation and dentigerous cyst which have a very good prognosis after
curettage so can require a close follow up of the patient and treatment and there is no recurrence.
more complicated treatment.

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Daniel Atieh Odontomes and Odontogenic Tumors Task 5

5) Elaborate on the differential diagnosis of ameloblastoma?

Reaching a differential diagnosis will depend on multiple factors. Radiographic appearance of a uni-locular or multi-
locular lesions on radiograph will lead a different differential diagnosis.

Uni-locular appearance can include:

1) Keratocystic odontogenic tumor (can also be multi-locular, usually no root resorption seen and no expansion
detected clinically)

2) Dentigerous cyst ( association with unerupted crown specially third molars)

3) Adenomatoid odontogenic tumor (young patients and favours anterior maxilla)

Multi-locular appearance can include:

1) Keratocystic odontogenic tumor

2) Giant cell granuloma (young patient and anterior to second molar, females affected more, expansion seen
clinically)

3) Odontogenic myxoma (septa create like a tennis-racket appearance in radiograph, expansion seen clinically)

4) Central Hemangioma (mandible, posterior region, second decade of life, soap bubble appearance in radiograph,
expansion seen clinically, may produce resorption of roots

6) Important histopathological features that help in the diagnosis of ameloblastoma?

A well differentiated cuboidal to columnar epithelium arranged as peripheral palisading cells (with minimal atypia) and
have reverse polarization (nuclei arranged away from basement membrane) with a centre of spindled epithelial cells
resembling stellate reticulum of enamel organ. Those stellate-like cells may keratinise or show granular changes.

7) Relation of histopathological type of ameloblastoma to treatment and prognosis?

Histologic subtypes does not affect treatment or prognosis of ameloblastoma.