The radiologic progression of ameloblastomas

Abstract

Background: In developing countries, many diagnosed cases of ameloblastoma (AB) have a significant delay in receiving treatment because of patient factors and healthcare facility constraints.

Objectives: The radiologic progression of ABs with delayed treatment was analysed using panoramic radiographs and cone-beam computed tomography imaging.

Method: Histopathologically confirmed cases of AB with follow-up radiographs indicating no treatment were retrospectively reviewed over a study period of 10 years. Fifty-seven cases with 57 initial and 107 follow-up radiographs were included. Each follow-up radiograph was analysed for changes in borders, locularity, effects on surrounding structures and lesion size.

Results: There was a general increase in poorly-demarcated lesions, with seven cases transforming from an initial unilocular to a multilocular appearance. At follow-up, there was an increase in cortical thinning and cortical destruction. Ameloblastomas presented with a three-fold increase in average size from the initial to follow-up visits. Regression analysis showed a statistically significant relationship between lesion duration and length (p = 0.001). A statistically significant relationship existed between duration and overall lesion dimensions when only the first and last observations per patient were used (p = 0.044).

Conclusion: Considering the aggressive nature and unlimited growth potential, ABs with delayed treatment may show extensive growth, complicating their eventual management.

Contribution: This study aimed to raise awareness of the importance of the timeous management of patients with AB by highlighting the detrimental effects of delayed treatment.

Keywords: ameloblastoma; benign odontogenic neoplasm; delayed treatment; maxillofacial radiology; neoplasm; progression.

FIGURE 1

Size measurement of an ameloblastoma on panoramic radiograph at initial presentation (a) and after 17 months (b). The yellow line represents the inferior border of the mandible. The blue line represents the anterior-posterior dimension and the green line the superior-inferior dimension.

FIGURE 2

Size measurement of an ameloblastoma on cone-beam computed tomography at initial presentation (a, b) and after 11 months (c, d). The blue line represents the anterior-posterior dimension, the green line the superior-inferior dimension, and the orange line the medial-lateral dimension.

FIGURE 3

(a) Well-defined unilocular ameloblastoma with scalloped margins causing root resorption and tooth displacement at initial visit. (b) The same lesion after 41 months presenting with a multilocular appearance, an increase in size and more severe root resorption.

FIGURE 4

Radiologic size measurement between baseline or initial imaging and subsequent follow-up appointments. The overall dimensions (volume) increased at each follow-up visit.

FIGURE 5

Ameloblastoma at initial presentation (a), 21 months follow-up (b) and 84 months follow-up (c). The lesion showed significant increase in size with loss of associated teeth.