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Ameloblastoma of the maxillary sinus: conservative surgical management considering high recurrence risk potential

Authors:
Lukas S Fiedler at SLK Kliniken Heilbronn GmbH
Lukas S Fiedler
Annette Wunsch at Klinikum Mutterhaus der Borromäerinnen
Annette Wunsch
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Abstract

Ameloblastoma (AM) in the maxillary sinus is rare. This benign entity shows locally invasive, destructive and aggressive behaviour and a high rate of recurrence. Therefore, the course of treatment is radical resection. We report the case of a 38-year-old man presenting with signs of recurrent sinusitis in the Ear, Nose and Throat Department. Transnasal flexible endoscopy revealed a cystic mass in the right inferior and middle nasal passage. CT scan showed an obliterated right maxillary sinus with a ballooning effect and pressure atrophy of the lateral sinus wall, without possible differentiation of the middle and low nasal turbinate. The patient was treated with transnasal functional sinus surgery; pathology stated AM. AM in the maxillary sinus is rare, locally destructive and therefore as a gold standard is resected radically to prevent recurrence. We demonstrate a conservative approach; explicitly, we combined a transvestibular and functional endoscopic sinus surgery resection of the AM to maintain function and reduce the possibility of postoperative impairments. Whether the strategy of treatment for AM is conservative, it nonetheless can result in a recurrence-free status. Nevertheless, inclusion into an oncological follow-up-programme with regularly performed MRI and CT is recommended.
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FiedlerLS, WunschA. BMJ Case Rep 2021;14:e241487. doi:10.1136/bcr-2020-241487
Ameloblastoma of the maxillary sinus: conservative
surgical management considering high recurrence
riskpotential
Lukas S Fiedler , Annette Wunsch
Case report
To cite: FiedlerLS,
WunschA. BMJ Case
Rep 2021;14:e241487.
doi:10.1136/bcr-2020-
241487
Otorhinolaryngology and Head
and Neck Surgery, Klinikum
Mutterhaus der Borromäerinnen
gGmbH, Trier, Deutschland,
Germany
Correspondence to
Dr Lukas S Fiedler;
l. fiedler@ gmx. at
Accepted 28 April 2021
© BMJ Publishing Group
Limited 2021. No commercial
re- use. See rights and
permissions. Published by BMJ.
SUMMARY
Ameloblastoma (AM) in the maxillary sinus is rare. This
benign entity shows locally invasive, destructive and
aggressive behaviour and a high rate of recurrence.
Therefore, the course of treatment is radical resection.
We report the case of a 38- year- old man presenting with
signs of recurrent sinusitis in the Ear, Nose and Throat
Department. Transnasal flexible endoscopy revealed
a cystic mass in the right inferior and middle nasal
passage. CT scan showed an obliterated right maxillary
sinus with a ballooning effect and pressure atrophy of
the lateral sinus wall, without possible differentiation
of the middle and low nasal turbinate. The patient
was treated with transnasal functional sinus surgery;
pathology stated AM. AM in the maxillary sinus is rare,
locally destructive and therefore as a gold standard is
resected radically to prevent recurrence. We demonstrate
a conservative approach; explicitly, we combined a
transvestibular and functional endoscopic sinus surgery
resection of the AM to maintain function and reduce
the possibility of postoperative impairments. Whether
the strategy of treatment for AM is conservative, it
nonetheless can result in a recurrence- free status.
Nevertheless, inclusion into an oncological follow- up-
programme with regularly performed MRI and CT is
recommended.
BACKGROUND
Ameloblastoma (AM) is a very rare, benign, locally
invasive tumour that can affect the sinuses and
shows a high recurrence rate. Therefore, the gold
standard therapy is radical resection.
CASE PRESENTATION
A 38- year- old man presented to an Ear, Nose and
Throat Department in a community care hospital
due to symptoms of recurrent sinusitis, which
subjectively started after an infection of the upper
airway. Since then, he suffered from nasal obstruc-
tion. Conservative treatment with a corticoid spray
for 1 month brought no improvement. Further-
more, medical anamnesis was clear, no relevant
medical event was recorded and laboratory results
showed no pathology.
INVESTIGATIONS
As presented in figure 1, flexible nasal endoscopy
revealed a cystic process in the right inferior and
middle nasal passage; there was no further clinical
pathology.
CT scans (see figure 2) of the paranasal sinuses
showed a completely obliterated right maxillary
sinus with a ballooning effect, formally of the
medial and lateral osseous boundary with suspi-
cious pressure atrophy (differential diagnosis:
destruction) and a hardly identifiable middle and
inferior conchae.
DIFFERENTIAL DIAGNOSIS
1. Odontogenic sinusitis: Up to 40% of chronic
bacterial maxillary sinus infections are attribut-
ed to a dental source; the CT scan would de-
mask evidence of periapical lucencies.1
2. Late- stage inverted papilloma (IP): IP can pres-
ent with unilateral nasal obstruction and rhinor-
rhoea; in the CT scan, IP in 28% presents in the
maxillary sinus, is mostly solid and can cause
bony erosions.2
3. Maxillary mucocele (MM): The MM is a slow-
growing, mucous- containing lesion lined with
epithelium that occurs due to ductal obstruc-
tion and can cause irregular osteolysis in the CT
scan.3
TREATMENT AND TIMELINE
Transnasal functional endoscopic sinus surgery
(FESS) under general anaesthesia was performed,
and histopathology revealed mucosa with chronic
sinusitis and a polypoid atypic proliferation. Due
to inconsistent results, pathology was referred and
stated the diagnosis of AM.
As seen in figure 3, a postoperative CT scan
showed a significant tumour regression with an
increasing ossification of the lateral maxillary sinus
in comparison with the primary CT (see figure 2).
Complementary MRI only showed cystic mucosal
areas and a peripheral mucosal enrichment, without
any signs of malignancy.
Our tumour board recommended a transvestib-
ular maxillary sinus surgery, with an intraoperative
histological examination and possibly resection of
the sinus floor including teeth extraction.
FESS was performed combined with trans-
vestibular partial mucosal resection of the right
ethmoidal cells and the right maxillary sinus—
further parts of the posterior wall of the maxil-
lary sinus. No tooth extraction was necessary. A
histological in sano resection was being achieved,
without a radical maxillectomy. No intraopera-
tive or postoperative complications disturbed the
patient’s recovery.
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2FiedlerLS, WunschA. BMJ Case Rep 2021;14:e241487. doi:10.1136/bcr-2020-241487
Case report
Figure 1 Transnasal flexible endoscopy with a cystic formation in the
middle nasal passage.
Figure 2 Preoperative coronary (left) and axial (right) CT scan with a
tumorous mass in the right maxillary sinus and pressure atrophy of the
lateral sinus wall (erosion).
Figure 3 Coronary (left) and axial (right) CT scans after functional
endoscopic sinus surgery.
Learning points
►Symptoms of sinusitis can mask a broad range of differential
diagnoses.
►In paranasal sinus tumours, due to radiographic findings a
definitive and precise diagnosis is not predictable; therefore,
obtaining of histology is essential.
►Ameloblastoma involving the maxillary sinus is rare and
shows a high recurrence rate.
►The gold standard of treatment for ameloblastoma is
radical resection, but conservative treatment options can be
discussed to minimise postoperative impairments probably
due to the difficulty to perform radical surgery at that site
►In conservative treatment options of ameloblastoma in the
maxillary sinus, a higher recurrence rate should be discussed
with the patient
OUTCOME AND FOLLOW-UP
The patient showed no functional problems or signs of recur-
rence within a follow- up period of 4 months. Radiographic MRI
scans showed a normal mucosal lining within the right maxillary
sinus, further regressive osseous defects of the lateral sinus wall.
DISCUSSION
AM is a histologically benign tumour and accounts for 1% of
all head and neck tumours.4 Although histopathologically AM is
classified as benign, residual postoperative tissue, for example,
in the maxillary sinus can affect the skull base and lead to fatal
complications. AM is 80% present within the mandible and 20%
within the maxilla. Most AM originate from gnathic tissue,5 and
a subset can occur from the epithelial lining of the maxillary
sinus.6 Listed in the WHO classification of odontogenic tumours
from 2017, AM can present as a unicystic type, extraosseous/
peripheral or metastasising.7 Given the fact that AM can arise
from follicular tissue of a upper third molar, we tried to organise
preoperative panoramic X- rays of the patient, which were not
existent.
The diagnosis of maxillary AM is commonly at a late stage8
and can be covered by symptoms of recurrent sinusitis. In our
case, a 38- year- old teacher, suffering from a blocked nose and
typical symptoms of recurrent sinusitis for over 2 months, was
planned for FESS. Preoperative planning led to a CT scan,
demasking a cystic lesion of the right maxillary sinus with suspi-
cious lateral pressure atrophy.
We performed FESS under general anaesthesia; this histo-
pathologically revealed chronic sinusitis and a polypoid atypic
proliferation. Due to inconsistent results, pathology was referred
and stated the diagnosis of AM.
AM slowly invades adjacent structures and tissue in a painless
and asymptomatic behaviour.5 This fact explains the late onset
of symptoms in our patient. While the duration of symptoms to
therapy was short, the extent and atrophy of bone were dispro-
portionally high.
Due to anatomical structures and the adjacent structures of
the maxilla, AM due to its invasion5 is further associated with
an aggressive course and can extend to the skull base.9 Given
the fact that recurrence is highly possible, the chosen main-
stay course of resection is radical.8 The current gold standard
of treatment for maxillary sinus AM is wide local excision with
clear margins and immediate reconstruction. Almost AM in this
region is treated with open partial maxillectomy10; further radi-
ation can be a feasible therapy option.8
In our case, we discussed the pathway with our patient—a
well- informed teacher—and decided to minimise the radicality
and chose a combined approach over FESS and transvestibular
partial mucosal resection of the right ethmoidal cells and the
right maxillary sinus. We further resected parts of the poste-
rior wall of the maxillary sinus. Given the fact that in our case
AM histologically seemed to be extraosseous and no radicular
involvement was seen, we decided not to extract teeth within
the operation. We aimed for a minimal functional impair and a
maximum outcome.
Risk factors of recurrence are discussed controversially; Yang
et al identified soft tissue or maxillary sinus involvement as statis-
tical risk factors of AM recurrence in 890 patients.9 Therefore
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Case report
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we incorporated the patient into our oncological after- care
programme. Here, we will periodically perform CT and MRI
scans and endoscopically check the nasal and paranasal sinuses
for signs of recurrence. Follow- up should be done for at least
10 years, as recurrence is possible after a long period of time,
especially in this case because there was no radical resection
performed. Since the patient is not that old, MRI is performed
every 6 months (last postsurgical control was also an MRI) and
could if necessary, for example, in unclear cases be comple-
mented by a CT. Clinical follow- up is also done and recalled
every 6 months.
Acknowledgements I acknowledge my chief of department Dr Schäfer and the
maxillofacial surgeon Dr Engels who operated on the patient and supported the
decision to publish the case.
Contributors LSF was involved in writing, selection of publications, editing and
revisions I and II. AW was involved in writing, review, editing and revision I.
Funding The authors have not declared a specific grant for this research from any
funding agency in the public, commercial or not- for- profit sectors.
Disclaimer Case reports provide a valuable learning resource for the scientific
community and can indicate areas of interest for future research. They should not be
used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
ORCID iD
Lukas SFiedler http:// orcid. org/ 0000- 0001- 9319- 8260
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... The number of included patients ranged between 1 and 24 [6][7][8][9][16][17][18][19][20][21][22][23][24][25][26], and the number of SNAs in each study ranged between 1 and 24 [6][7][8][9][16][17][18][19][20][21][22][23][24][25][26]. Included studies described SNAs in 38 individuals [6][7][8][9][16][17][18][19][20][21][22][23][24][25][26]. As reported by thirteen studies, 30 of the patients were males, and 6 of them were females [6][7][8][9]16,17,[19][20][21][22][23][24][25] and the age of the patients ranged between 14 and 81 years old, with the mean age at 56.90 years [6][7][8][9][16][17][18][19][20][21][22][23][24][25][26]. ...
... Included studies described SNAs in 38 individuals [6][7][8][9][16][17][18][19][20][21][22][23][24][25][26]. As reported by thirteen studies, 30 of the patients were males, and 6 of them were females [6][7][8][9]16,17,[19][20][21][22][23][24][25] and the age of the patients ranged between 14 and 81 years old, with the mean age at 56.90 years [6][7][8][9][16][17][18][19][20][21][22][23][24][25][26]. In one study, the age of the patient was not provided [26]. ...
... Included studies described SNAs in 38 individuals [6][7][8][9][16][17][18][19][20][21][22][23][24][25][26]. As reported by thirteen studies, 30 of the patients were males, and 6 of them were females [6][7][8][9]16,17,[19][20][21][22][23][24][25] and the age of the patients ranged between 14 and 81 years old, with the mean age at 56.90 years [6][7][8][9][16][17][18][19][20][21][22][23][24][25][26]. In one study, the age of the patient was not provided [26]. ...
Clinicopathologic Profile, Management and Outcome of Sinonasal Ameloblastoma—A Systematic Review
Article
Full-text available
  • Jan 2023
Sinonasal ameloblastoma (SNA) is considered to be a subtype of ameloblastoma. It differs from gnathic ameloblastoma in terms of clinicopathologic features, management and prognosis. Thus, the objective of the present review was to study the complications, survival, recurrence rate and outcomes following the management of SNA. The electronic search process was conducted on PubMed-Medline, Embase, and Scopus. Google Scholar was used to search grey literature. Quality assessment of the case reports (CR) and case series (CS) was done based on CARE guidelines. The initial search resulted in 2111 articles. 15 studies (13 CR and 2 CS) were found to meet the eligibility criteria. The majority of the studies described histological features of SNA, which were consistent with ameloblastomas of gnathic origin. There were no SNA-related deaths reported in the included studies. Five studies described endoscopic surgeries to remove SNAs, and three SNAs were treated with post-surgery radiotherapy. Data from included studies suggest that sinonasal ameloblastomas are histologically similar to gnathic ameloblastomas, but their clinical presentation is different. They may cause complete or partial obstruction of the nasal cavity and the sinus. They appear to affect an older demographic, and their resection may be accompanied by the excision of a large portion of the maxilla, necessitating maxillofacial prosthetic rehabilitation.
View
... Many patients are diagnosed at an advanced tumor stage beyond the maxilla. Late MAs can cause (usually unilateral) facial swelling/deformity, intraoral ulceration, tooth-and/or headache, nasal obstruction, epistaxis, and visual disturbances [1][2][3]. ...
... In this case, a conservative alternative can be applied, e.g. transnasal functional endoscopic sinus surgery (FESS) to approach the cranial base [3,31], or even the intracranium [2,41]. Recently, Guha et al. [31], and Fiedler and Wunsch [3] showed treatment of MAs with SBI using FESS combined with a Feldmann's transantral osteoplastic ethmoidectomy. ...
... transnasal functional endoscopic sinus surgery (FESS) to approach the cranial base [3,31], or even the intracranium [2,41]. Recently, Guha et al. [31], and Fiedler and Wunsch [3] showed treatment of MAs with SBI using FESS combined with a Feldmann's transantral osteoplastic ethmoidectomy. However, they had short spans of follow-up (4 and 18 months). ...
A retrospective cohort study on predictors associated with skull base invasion of maxillary ameloblastomas
Article
  • Mar 2022
Purpose To identify factors associated with skull base involvement (SBI) of maxillary ameloblastomas (MA). Methods This retrospective cohort study was composed of MA patients treated during a 7-year period. Demographic, radiographic, and nine immunohistopathologic predictor variables were included. The outcome variable was presence of SBI (yes/no). Descriptive, bi- and multivariate statistics were computed, and P ≤ .05 in multivariate analyses was considered statistically significant. Results The sample comprised 23 subjects (34.8% females; 21.7% with SBI) with a mean age of 50.3 ± 18.2 years. Candidate predictors of an SBI in MAs were 1) male gender, 2) a low Karnofsky Performance Status score (KPS), 3) multilocular radiolucency, 4) ill-defined margins, 5) cortical perforation, 6) inclusion of an unerupted tooth, 7) moderate to strong reactivity to p53, Ki-67, CD10, astrocyte elevated gene-1 (AEG-1) protein, carbonic anhydrase IX (CA IX), calretinin (calbindin2; CALB2), and BRAF-V600E, and 8) negative to low immunopositivity to α-smooth muscle actin (α-SMA) and syndecan-1 (CD138). However, multivariate analyses confirmed the significant associations of SBI with negative/low syndecan-1 reactivity (P = .003; adjusted odds ratio [ORadj.], 4.04; 95% confidence interval [95% CI], -.89 to -.48; Pearson's Correlation Coefficient [r] = -.74) and with KPS (P = .003; ORadj., 4.04; 95% CI, -.78 to -.17; r = -.54) only. Conclusions Our findings suggest an aggressive approach to MAs with negative to low syndecan-1 immunopositivity and/or in multi-morbid patients (who may have difficulty in access to health care). Otherwise, health care inequalities due to low KPS scores should be minimized or eliminated.
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A Rare Case of Deceptive Maxillary Ameloblastoma
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  • Jan 2023
Ameloblastoma (AM) is a rare epithelium-derived odontogenic tumor, mostly involving the mandible and less often the maxilla. Most AMs are benign and characterized by indolence and local invasiveness, with a high recurrence rate. Herein, we present a case of maxillary AM in a 42-year-old female suffering from left nasal congestion and facial swelling for almost one month after endoscopic surgery at a local hospital. The mass was completely resected by a transnasal functional endoscopic sinus surgery based on radiographic examination. Subsequently, postsurgical histopathological examinations were conducted, and she was diagnosed with a plexiform AM pattern. Immunohistochemical staining revealed that the tumor was positive for PCK, P63, CK5/6, and CK14 but negative for S100, ER, and Ki67. Based on these findings, the patient was diagnosed with maxillary AM.
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Maxillary Sinus Ameloblastoma: Transnasal Endoscopic Management
Article
Full-text available
Ameloblastoma (AM) is a slow growing and aggressive benign tumor with an odontogenic epithelial origin arising from the mandible or maxilla. The odontogenic neoplasm invades local tissues asymptomatically and accounts for 1% of oral tumors and over 10% of odontogenic tumors. A 64-year-old man with a history of allergic fungal rhinosinusitis (AFRS) undergoing a revision image-guided endoscopic sinus surgery was found to have a fibrous mass suspicious of malignancy projecting inferolaterally and attached to the floor of the left maxillary sinus. Diagnostic biopsies were taken, and additional surgery was required to successfully resect the tumor via a transnasal endoscopic dissection. Multiple permanent pathology samples concluded the diagnosis of an AM. Endoscopic investigations led to the incidental discovery and ultimate complete endoscopic resection of the AM. The utilization of an endoscopic resection compared to the traditional maxillectomy with reconstruction results in significant less short and long-term morbidity for the patient.
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Sinus Floor Augmentation in Presence of Mucocele Eroding Maxillary Sinus Wall: A Case Report With 3 Years Follow‐Up
Article
Full-text available
  • Nov 2019
Introduction The maxillary mucocele is a slow‐growing aggressive lesion and a mucous‐containing sac lined with epithelium that occurs due to ductal obstruction and self‐limiting injury. Rarely, it may be associated with non‐specific symptoms. It is characterized by bone resorption due to its expanding behavior. Reduced height of bone and sinus pneumatization associated with pathologic lesions located in the floor of maxillary sinus may impede sinus augmentation. Therefore, careful diagnosis and management of pathology before sinus floor elevation is important in determining its recurrence and prognosis. Case Presentation We reported a case with small mucocele on right pneumatized antrum with insufficient residual bone height for implant placement. Radiograph in the region of teeth #3 and #4 revealed a homogeneous solitary radiopaque mass. Cone‐beam computed tomography revealed irregular osteolysis of the lateral wall of the sinus. It was excised through Caldwell‐Luc technique and simultaneous sinus augmentation was performed. Later, delayed implant restoration was performed. No complication or recurrence was reported during 36 months of follow‐up. Conclusions The excision of mucocele on sinus floor and simultaneous sinus augmentation obviates the need for the extended treatment period. The clinician must be habituated with the anatomy and pathology of the maxillary sinus to evade any non‐essential complications following lateral sinus floor augmentation procedure. A diminutive mucocele should not be regarded as a contraindication for sinus augmentation; sometimes it manifests with bone erosion. The prompt diagnosis and careful evaluation are needed to avoid future complications during implant therapy.
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Sinonasal Ameloblastoma
Article
Full-text available
  • Jun 2019
Ameloblastomas are benign but aggressive odontogenic tumors that most commonly affect the posterior mandible. Approximately 15% occur in the maxilla, with a subset thought to originate from the epithelial lining of the sinonasal cavities. Histologically, sinonasal ameloblastomas are identical to those of the oral cavity, with classical features of palisaded columnar basilar cells surrounding a central proliferation that resembles the stellate reticulum of a developing tooth. Unlike the gnathic variant, sinonasal ameloblastomas tend to affect males more than females, and the incidence of diagnosis peaks at a later age, approximately 60 years old. The overall prognosis is favorable, with local recurrence being the most common long-term sequalae.
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Odontogenic tumors: where are we in 2017 ?
Article
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  • Nov 2017
Odontogenic tumors are a heterogeneous group of lesions of diverse clinical behavior and histopathologic types, ranging from hamartomatous lesions to malignancy. Because odontogenic tumors arise from the tissues which make our teeth, they are unique to the jaws, and by extension almost unique to dentistry. Odontogenic tumors, as in normal odontogenesis, are capable of inductive interactions between odontogenic ectomesenchyme and epithelium, and the classification of odontogenic tumors is essentially based on this interaction. The last update of these tumors was published in early 2017. According to this classification, benign odontogenic tumors are classified as follows: Epithelial, mesenchymal (ectomesenchymal), or mixed depending on which component of the tooth germ gives rise to the neoplasm. Malignant odontogenic tumors are quite rare and named similarly according to whether the epithelial or mesenchymal or both components is malignant. The goal of this review is to discuss the updated changes to odontogenic tumors and to review the more common types with clinical and radiological illustrations.
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Améloblastome du sinus maxillaire traité par radiothérapie
Article
Full-text available
  • Mar 2017
L’ameloblastome est une tumeur odontogene benigne a caractere agressif qui necessite un diagnostic precoce et un traitement adequat. Son site habituel est la mandibule et la chirurgie radicale demeure le traitement de reference. Nous rapportons le cas d’un ameloblastome a localisation sinusienne maxillaire localement tres avance que nous avons traite par radiotherapie conformationnelle avec modulation d’intensite. L’evolution a ete marquee par une remission de la maladie avec un recul de 24 mois. La localisation maxillaire d’un ameloblastome est rarement decrite, diagnostiquee a un stade tardif le plus souvent ou la chirurgie optimale est impossible. A travers cette observation nous demontrons que la radiotherapie constitue une veritable alternative therapeutique dans les formes evoluees et inoperables des ameloblastomes.
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Multi-recurrent invasive ameloblastoma: A surgical challenge
Article
Full-text available
  • Nov 2016
Introduction: Ameloblastomas are rare head and neck tumors, and yet the most common odontogenic neoplasms. They account for 1% and 11% of all head and neck and odontogenic tumors respectively. Embryologically, they originate from remnants of odontogenic epithelium. Their aggressive, destructive nature, as well as their anticipated high rate of recurrence, even after en bloc resection, poses a surgical predicament. Presentation: We present a case of a 56 year-old Asian female with a multi-recurrent invasive ameloblastoma. Initially, the lesion was mandibular in location for which she underwent a mandiblectomy. Later on, she presented with a maxillary ameloblastoma with invasion of both the anterior wall of the maxillary sinus and the floor of the orbit. The patient was operated twice and histopathology confirmed a cystic type recurrent ameloblastoma. A year later, she came with recurrent maxillary ameloblastoma and a maxillectomy was done. However, histopathology revealed a follicular ameloblastoma. Three years later, she presented with a retro-orbital ameloblastoma with infiltration to the temporal muscles. The patient was operated and the histopathologic examination revealed a partially cystic lesion with no malignant transformation. Conclusion: This case discusses available treatment options and emphasizes on the importance of long-term patient follow-up due to the biological behavior of ameloblastoma.
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Maxillary ameloblastoma: Factors associated with risk of recurrence
Article
  • Feb 2017
  • HEAD NECK-J SCI SPEC
Background: Maxillary ameloblastomas are rare and associated with an aggressive course because of the anatomic composition of the maxilla and adjacent structures. The risk factors associated with recurrence were analyzed in this retrospective study. Methods: Cases of maxillary ameloblastoma reported in a tertiary hospital from 2005 to 2015 were analyzed to identify clinicopathological and radiological factors associated with recurrence using univariate and multivariate Cox regression analyses. Results: A total of 890 patients with ameloblastomas were treated in this study, of whom only 51 (5.7%) had maxillary ameloblastomas. The median follow-up period was 56 ± 28.65 months. Of the maxillary ameloblastomas, 29 (56.8%) were primary and 22 (43.1%) were recurrent. Soft tissue or maxillary sinus invasion and primary or recurrent tumor status were risk factors significantly associated with recurrence in the univariate analyses (p = .006 vs p = .025, respectively), whereas the association between recurrence and surgical methods was borderline significant (p = .08). The multivariate Cox regression analysis showed that soft tissue or maxillary sinus involvement was significantly associated with recurrence (p = .023). Conclusion: Recurrent tumors and tumors with soft tissue or maxillary sinus involvement were risk factors for recurrence among patients with maxillary ameloblastoma. © 2017 Wiley Periodicals, Inc. Head Neck, 2017.
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Ameloblastoma: a clinical review and trends in management
Article
  • Apr 2015
  • Eur Arch Oto Rhino Laryngol
Ameloblastoma is a rare odontogenic neoplasm of the mandible and maxilla, with multiple histologic variants, and high recurrence rates if improperly treated. The current mainstay of treatment is wide local excision with appropriate margins and immediate reconstruction. Here we review the ameloblastoma literature, using the available evidence to highlight the change in management over the past several decades. In addition, we explore the recent molecular characterization of these tumors which may point towards new potential avenues of personalized treatment.
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Papilomas invertidos rinosinusales. Revisión de 61 casos
Article
  • Nov 2009
  • Acta Otorrinolaringol Esp
IntroductionInverted papillomas are benign sinonasal lesions that arise primarily from the lateral nasal wall which are characterized by their tendency to recur and propensity to be associated with malignancy. The aim of this work is to analyze our experience in the treatment of these lesions, especially through the endoscopic approach.
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Odontogenic sinusitis: An ancient but under-appreciated cause of maxillary sinusitis
Article
  • Dec 2011
  • Curr Opin Otolaryngol Head Neck Surg
For well over 100 years, it has been appreciated that maxillary dental infections can cause sinusitis. This insight has been largely overlooked with the advent of functional endoscopic sinus surgery (ESS) and its emphasis on the osteomeatal complex. We review several recent case series and reviews of odontogenic sinusitis that characterize and discuss emerging diagnostic modalities in odontogenic sinusitis. In recent publications on odontogenic sinusitis, up to 40% of chronic bacterial maxillary sinus infections are attributed to a dental source, which is far higher than the previously reported incidence of 10%. Plain dental films and dental evaluations frequently fail to detect maxillary dental infection that can be causing odontogenic sinusitis. However, sinus computed tomography (CT) or Cone Beam Volumetric CT (CBVCT) are far more successful in identifying dental disease causing sinusitis. The microbial pathogens of odontogenic sinusitis remain unchanged from earlier reviews; however, the clinical findings in odontogenic sinusitis are better described in recent reviews. Successful treatment of odontogenic sinusitis requires management of the odontogenic source and may require concomitant or subsequent sinus surgery. Odontogenic sinusitis is frequently recalcitrant to medical therapy and usually requires treatment of the dental disease. Sometimes dental treatment alone is adequate to resolve the odontogenic sinusitis and sometimes concomitant or subsequent ESS is required. Evaluation of all patients with persistent chronic rhinosinusitis (CRS) should include inspection of the maxillary teeth on CT scan for evidence of periapical lucencies. Unilateral recalcitrant disease associated with foul smelling drainage is especially characteristic of odontogenic sinusitis. High-resolution CT scans and CBVCT can assist in identifying dental disease.
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