하악골에 발생한 거대한 법랑아세포종의 외과적 치험례

A CASE REPORT OF GIANT AMELOBLASTOMA IN THE MANDIBLE

Ameloblastoma is one of the most controversial tumors of jaws. Greater diversity of opinion was existed concerning the terminology, etiology, diagnosis, microscopic classification, clinical behavior, treatment, & malignant potential of this tumor than perhaps of any other neoplasm found anywhere in the body. The many different names for it, indicating misunderstanding as to the cel of origin, have led to confusion. Baden found that more than 50 terms had been used and suggested the new term odontogenic epithelioma. Ameloblastoma is a benign but locally invasive neoplasm consisting of proliferating odontogenic epithelium lying in a fibrous stroma. Usually the ameloblastomas are diagnosed in the fourth & fifth decades. Over 80% of them occur in the mandible, the remainder in the maxilla. Radiographically, the ameloblastoma may show considerable variations. The typical picture is of a multilocular destruction of bone, but unilocular ameloblastomas also occur. The histological pattern of the ameloblastoma varies greatly and the following types are commonly described: follicular, plexiform, acanthomatous, basal cell and granular cell types. The preferred treatment for ameloblastoma is radical excision, conserving (when possible) the inferior border of the mandible. The excision is carried beyond the neoplasm into healthy tissue. We had a chance to meet a 22-year-old female patient who was admitted to the Dept. of Oral Surgery. of S.N.U.H. with chief complaint of gigantic swollen mass of left half of the lower jaw. After some investigations, we had an operation of hemimandibulectomy without immediate graft. The results are as followings; 1. The bony expansion from symphysis to coronoid process and lingual migration of left lower premolars can be seen. 2. Computerized tomography is helpful for the diagnosis of the infiltrative, expansive lesion involving mandibular ramus. 3. Scooping of internal surface of cortical bone and localized thickening of cortical bone can be seen as a result of computerized tomography 4. Due to chronic inflammation immediate graft is impossible but reconstructive surgery should be done as soon as possible, after some detailed investigations. 5. After operation, there are improvements in esthetic problem, intraoral foul odor, and saliva dribbling.