Ameloblastoma in Nigerian Children and Adolescents: A Review of 79 Cases

doi:10.1016/j.joms.2004.04.037

Journal of Oral and Maxillofacial Surgery

Volume 63, Issue 6, June 2005, Pages 747-751

https://doi.org/10.1016/j.joms.2004.04.037 Get rights and content

Purpose

To descriptively review the clinicopathologic presentation and management of ameloblastoma in Nigerian children and adolescents and compare this with previous reports in the literature.

Methods and Materials

Data were collected from the case files of patients managed at 4 tertiary referral centers in Nigeria.

Results

Out of a total of 360 patients with a diagnosis of ameloblastoma, 79 were under 20 years of age at presentation (21.9%). Only 2.5% of the patients were under 10 years of age. The male-female ratio was 1.3 to 1 with a peak age incidence of 15 years in males and 17 years in females. All the tumors were intraosseous and the majority (94.9%) were situated in the mandible. The most common morphologic type was solid multicystic ameloblastoma (82.3%). The majority (66.2%) had a multilocular radiographic presentation. In most patients (57.3%), the symphysial region of the mandible was involved by the tumor. However, exclusively anterior tumors constituted only 15.2% of the cases, while tumors involving anterior and posterior jaw regions constituted 41.1%. Resection was the predominant (72.2%) form of surgical management.

Conclusion

Ameloblastoma in Nigerian children and adolescents exhibit some peculiar clinical features: these include the predominance of males, and of the solid multicystic morphologic type. In addition, there is site predilection for the symphysial region of the mandible. Radical surgical resection remains the predominant form of treatment. Therefore, varying degrees of interference with facial growth will be present in these children.

Section snippets

Materials and Methods

Case files of patients under 20 years of age who presented with a histologically diagnosed ameloblastoma at 4 tertiary referral centers in Nigeria were reviewed. There were 35 patients from Lagos University Teaching Hospital (1980–1998); 18 patients from University College Hospital, Ibadan (1980–1998); 16 patients from Ahmadu Bello University Teaching Hospital, Kaduna (1990–1998); and 9 patients from Obafemi Awolowo University Teaching Hospital, Ile-Ife (1990–1999). The parameters extracted

General

Seventy-nine of 360 patients with a histologic diagnosis of ameloblastoma were under 20 years of age at presentation (21.9%). Six patients presented with recurrent lesions (7.6%) and 4 had infected lesions (5.1%).

Age and gender

The youngest patient in this study was a 6-year-old boy (Fig 1). The most frequently affected age was 17 years (17.5%). However, the peak age incidence in males was 15 years compared with 17–18 years in females. There were 45 males and 34 females, a ratio of 1.3 to 1. However, in

Discussion

The management of ameloblastoma in young patients is challenging because of concerns for facial growth. A review of previous studies of this locally infiltrative benign neoplasm in the first 2 decades of life shows wide variation in age selection. While Daramola et al,¹⁴ Olaitan and Adekeye,¹² and Chidzonga¹⁵ selected patients who were 18 years or younger, Khan¹⁰ and Ord et al¹⁶ selected patients under 20 years of age. The incidence of 21.9% of ameloblastoma in children found in this study is

Acknowledgment

The authors acknowledge the contributions of past and present consultants in the hospitals where these patients were managed.

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Cited by (44)

Management of large pediatric ameloblastoma: Conservative approach with 4-years follow up
2019, Oral and Maxillofacial Surgery Cases
Ameloblastoma is a rare, benign, slowly growing, locally invasive, odontogenic tumor of epithelial origin with high recurrence rate. We present a case of large unicystic ameloblastoma in a 13-year old girl. The tumor involved the right mandibular body, ramus and condyle and surrounded the crown of an unerupted second molar. Conservative surgery was chosen as a first choice treatment in order to preserve the structural and functional integrity of the mandible. No recurrence was observed during a 4-year follow-up.
Biological profile of ameloblastoma and its location in the jaw in 1246 Nigerians
2018, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Citation Excerpt :
The peak age of occurrence of ameloblastoma was in young adulthood, a finding that has been similarly reported in other Nigerian publications,8,19 followed by adulthood and adolescence. The male-to-female ratio was similar to that reported in other studies performed in Nigeria,10,2021 Northern Brazil,22 and India,23 but slightly different from that in studies in Malaysia, South Korea, and China (male-to-female ratio 1.4:1).24-26 We found fewer lesions in the maxilla than in the mandible, which is similar to the findings from the Chinese population, which has a reported maxilla-to-mandible ratio of 1:4.25
Ameloblastoma is a benign, slow-growing, locally invasive epithelial tumor of odontogenic origin, with unlimited growth capacity and a strong tendency to recur. This multicentric study analyzed ameloblastoma diagnosed in Nigeria among different ethnic groups.
This retrospective study included ameloblastoma cases diagnosed from 1964 to 2017 at 10 hospitals or medical centers in Nigeria. Age, sex, tribe, and location of the ameloblastoma in the jaw were analyzed. Associations between variables were tested by using χ² and Fisher's exact test.
A total of 1246 ameloblastoma cases were recorded (mean patient age 32.51 ± 14.54 years; range 4-86 years; male-to-female ratio 1.2:1). Approximately 60% of ameloblastoma cases occurred in young adults (age range 18-40 years). Ninety-eight lesions were located in the maxilla and 1103 in the mandible; the posterior mandible was the most common site (31.3% on the right and 26.5% on the left, respectively), followed by the anterior (26.0%) mandible. No significant differences were noted in the distribution of ameloblastoma within the tribes with respect to age (P = .92) and sex (P = .71).
The mandible is a common site of ameloblastoma in patients in Nigeria, and in most cases, it occurs in young adults. Early presentation, diagnosis, and treatment are important to reduce postoperative disfigurement and morbidity.
Recurrence rate following treatment for primary multicystic ameloblastoma: Systematic review and meta-analysis
2016, International Journal of Oral and Maxillofacial Surgery
Opinions regarding the treatment of multicystic ameloblastoma are divergent due to its benign nature and the high rate of recurrence if not adequately excised. The aim of the present study was to perform a systematic review of the literature for a qualitative and quantitative assessment of studies addressing primary multicystic ameloblastoma with regard to treatment and recurrence. Searches were conducted of the Ovid Medline and Embase databases for articles published up to January 2014. Based on predefined eligibility criteria, studies were selected in a two-stage screening process conducted by two independent reviewers. Quality assessment of the selected articles was performed using the modified criteria of the Agency for Healthcare Research and Quality. The meta-analysis was performed using Review Manager (RevMan) software. Statistical heterogeneity was investigated by performing a χ² test at the 5% significance level (P < 0.05) and determining I². The relative risk of recurrence was 3.15-fold greater (95% confidence interval 1.98–5.00) when conservative treatment was performed on primary multicystic ameloblastoma in comparison to radical treatment (P < 0.00001 for treatment effect; I² = 0% and P = 0.48 for heterogeneity). The findings justify the treatment of primary multicystic ameloblastoma with bone resection.
The occurrence and pattern of ameloblastoma in children and adolescents: An Indian institutional study of 41 years and review of the literature
2015, International Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
There was a marked predilection for the mandible (97.4%), with the body–ramus–angle region being the most represented site, which is similar to other studies.3,5,7–11,13–17,19 In the reported literature, radiologically multilocular ameloblastomas were predominant over unilocular lesions, whereas in the present study a predominance of unilocular ameloblastomas (59.0%) was found.5,7,10–12 In our series, on microscopic examination no significant difference was found between the occurrence of solid ameloblastoma (51.3%) and unicystic ameloblastoma (48.7%).
Ameloblastoma in the paediatric age group is considered a rarity and it accounts for approximately 10–15% of all reported cases. This study assessed the clinical, radiological, and histopathological features of 39 cases of ameloblastoma in Indian children aged less than 18 years, seen over a 41-year period (1971–2011) in the Department of Oral Pathology, Nair Hospital Dental College, India. Out of 256 diagnosed cases of ameloblastoma, 39 (15.2%) occurred in patients ranging in age from 4.5 to 18 years (mean age 13.6 years; male-to-female ratio 2:1). All of the tumours were intraosseous, with a marked predilection for the mandible (97.4%), the body–angle–ramus being the most commonly involved site. Radiographically, 23 cases presented as unilocular radiolucency. Histologically, 20 cases presented as solid and 19 as unicystic ameloblastoma. The interesting finding of 10 solid ameloblastoma presenting as unilocular radiolucency and five cases of unicystic ameloblastoma manifesting as multilocular radiolucency suggests that solid ameloblastomas should be included in the differential diagnosis of unilocular radiolucency of the jaw in the paediatric age group.
Unicystic ameloblastoma in children: Systematic review of clinicopathological features and treatment outcomes
2014, International Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
The treatment of UA remains controversial. According to Arotiba et al.,48 wide resection should be the treatment of choice in an environment where follow-up examinations are limited and patients ignore their symptoms for long periods. Scariot et al.33 also believe that a more aggressive surgical approach should be considered when the condition recurs more than twice, or when required by the patient.
The purpose of this study was to review the clinical, radiological, and histopathological profile of unicystic ameloblastoma (UA) in children using data from available case reports and reviews published between 1992 and 2012. A total of 513 publications were evaluated. A structured search of the literature was performed, with predefined criteria, using computer and manual searches. An evaluation and critical appraisal was done in three separate rounds. A total of 25 articles describing 51 cases satisfied the selection criteria and were thus included in the final review. UA was mostly found to be located in the mandible, often exhibiting a unilocular radiographic image. Enucleation alone resulted in the highest recurrence rate. According to the results of this study, luminal UAs are less aggressive and respond better to conservative treatment. In contrast, plexiform and mural types frequently result in recurrence. The use of Carnoy's solution in preventing recurrence remains to be established.
Ameloblastoma: A retrospective study of 48 cases
2013, Revista Espanola de Cirugia Oral y Maxilofacial
El ameloblastoma es un tumor odontogénico benigno, localmente invasivo y recidivante, que constituye aproximadamente el 11% de los tumores odontogénicos. Estos tumores ocurren más frecuentemente en la mandíbula. El cuadro clínico se caracteriza generalmente por presentar deformaciones faciales, crecimiento lento y asintomático. El tratamiento depende del tipo, la localización y el tamaño del tumor, así como de la edad del paciente. El objetivo del presente trabajo es realizar un estudio retrospectivo de los casos diagnosticados de ameloblastomas en los datos existentes de los archivos del Departamento de Patología Oral de la Pontifícia Universidade Católica de Minas Gerais, Brasil. Se analizaron los archivos de pacientes en el periodo de enero de 1978 a marzo de 2012, con un diagnóstico definitivo de ameloblastoma.
Fueron analizadas las informaciones con respecto a sexo, raza, edad del paciente, presencia de síntomas, aspecto radiográfico del tumor, diagnóstico histopatológico y ubicación anatómica.
Dentro de los 48 pacientes con ameloblastoma se observó mayor incidencia en la mandíbula en la zona del cuerpo y ángulo (45,8%), que afecta por igual a hombres y mujeres, con un promedio de edad de 36 años y en su gran mayoría se mostraron asintomáticos (81,2%). El tipo más frecuente fue el multiquístico (66,7%), seguido por el uniquístico (31,2%) y el periférico (2,1%). La mayoría de lesiones fueron observadas en la raza blanca (56,3%) y radiográficamente se mostró más frecuente la imagen multilocular (60,4%).
Los datos de los ameloblastomas reportados en este estudio fueron similares a los de otras series publicadas en la literatura médica.
Ameloblastoma is a benign, locally invasive and recurrent, odontogenic tumor, which accounts for about 11% of odontogenic tumors. These tumors occur more frequently in the mandible. The clinical picture presented is generally characterized by slow growing and asymptomatic facial deformities. Treatment depends on the type, location and size of the tumor, as well as the age of the patient. The aim of this paper is to present a retrospective study of diagnosed cases of ameloblastoma in existing data files of the Department of Oral Pathology Catholic University of Minas Gerais, Brazil. Data was collected from the files of patients with a definitive diagnosis of ameloblastoma during the period January 1978 to February 2012.
An analysis was made of the data, including sex, race, patient age, symptoms, radiographic appearance of the tumor, the histopathological diagnosis and anatomic location.
Of the 48 patients with ameloblastoma there was an increased incidence in the jaw and the angle (45.8%). It affected both men and women, with a mean age of 36 years, and the large majority were asymptomatic (81.2%). The most frequent histological type was multicystic (66.7%), followed by unicystic (31.2%), and peripheral (2.1%). Most lesions were observed in white people (56.3%) and radiographically, it was more often a multilocular image (60.4%).
The data reported in this study of ameloblastomas were similar to other series reported in the medical literature.

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Clinical articleAmeloblastoma in Nigerian Children and Adolescents: A Review of 79 Cases

Purpose

Methods and Materials

Results

Conclusion

Section snippets

Materials and Methods

General

Age and gender

Discussion

Acknowledgment

Oral Surg Oral Med Oral Pathol

Oral Surg

J Oral Maxillofac Surg

J Am Dent Assoc

Br J Oral Maxillofac Surg

Oral Surg

Oral Surg Oral Med Oral Pathol

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Clinical article
Ameloblastoma in Nigerian Children and Adolescents: A Review of 79 Cases