Ameloblastoma: Symptoms, Causes, and Treatment in Chicago

Types of Ameloblastoma

Ameloblastomas develop from the same cells that make up tooth enamel. There are four main types of ameloblastoma:

• Conventional ameloblastoma. This form is slow-growing but aggressive, causing significant damage, and typically develops in the lower jawbone. It tends to recur.
• Unicystic ameloblastoma. This form typically appears in younger people and may be mistaken for a cyst. It is usually seen at the back of the lower jawbone, near the molars.
• Peripheral ameloblastoma. This form is rare, accounting for only about 1% of all oral tumors, and occurs in the gums or other soft tissues of the mouth. It has a lower risk of recurrence.
• Metastasizing ameloblastoma. This rare form accounts for only 1%-4% of all ameloblastomas. It is diagnosed when the tumor cells spread to another part of the body, most commonly the lymph nodes in the neck or the lungs.

While ameloblastoma is not cancer, left untreated, it can develop into cancer. Malignant ameloblastoma is extremely rare, accounting for less than 1% of all cases.

Symptoms of Ameloblastoma

Ameloblastoma often has no symptoms and may present as a small lump or swelling in the jaw that is easily ignored. Sometimes, ameloblastoma is discovered during a routine dental X-ray. As it grows, however, symptoms become more pronounced. The benign jaw tumor signs and symptoms may begin to affect other structures of the mouth and face, including the mouth floor, sinuses, or eye sockets, as well as nerves and blood vessels. 

Signs of ameloblastoma may include:

• Painless swelling at the back of the jaw
• Tooth or jaw pain
• Loose teeth unrelated to gum disease (as the growth of the tumor displaces them)
• Difficulty chewing
• Facial asymmetry (as the tumor becomes larger and/or infiltrates other structures)

Any persistent swelling or growth on your jaw, even if it’s painless, should be evaluated by a dentist or oral surgeon.

Causes and Risk Factors of Ameloblastoma

Ameloblastoma begins in the cells that form the enamel of your teeth and, rarely, in the cells that form gum tissue. Most ameloblastomas appear in adults aged 30 to 60, but some forms, especially unicystic ameloblastoma, can occur in younger people.

There is no known cause for ameloblastoma, but researchers have identified some risk factors.

• Genetics. There is a strong genetic component associated with ameloblastoma. Mutations in the BRAF and SMO genes have been identified in over 80% of ameloblastoma cases. Overexpression of other genes has also been identified as a risk factor.
• Ethnicity. Ameloblastoma is more common in Asian and African populations. 
• Jaw Trauma or Dental Infection. Research suggests that a history of trauma to the jaw or dental infections could raise your risk of developing ameloblastoma.

Diagnosing Ameloblastoma

Ameloblastoma is typically diagnosed with imaging tests and a tissue sample.

• X-ray. X-rays can be used to diagnose ameloblastoma. Sometimes your dentist will spot ameloblastoma during a routine dental X-ray. 
• 3D Cone Beam Computed Tomography (CBCT). By rotating the 3D images produced by this special CT scan, our oral surgeons can see the exact size, location, borders, and internal changes of the ameloblastoma.
• Biopsy. Your doctor will take a tissue sample from the tumor site to confirm the diagnosis and evaluate the type of ameloblastoma and how aggressive it is.

Ameloblastoma Treatment

Ameloblastoma is treated with surgical removal of the tumor, followed by reconstruction, if necessary. Radiation therapy may be considered to help prevent recurrence. 

Ameloblastoma Surgery

Because ameloblastoma tends to recur, your surgeon will want to ensure that the entire tumor is removed. Depending on the amount of damage the tumor has done to the jawbone and other structures, this may involve a partial mandibulectomy or maxillectomy.

• Mandibulectomy. This surgery removes the part of your lower jaw affected by ameloblastoma, along with a margin.
• Maxillectomy. This surgery removes part of your upper jaw affected by ameloblastoma, along with a margin.
• Segmental Resection. This is a form of mandibulectomy or maxillectomy where an entire segment of bone is removed. Segmental resection may be necessary in cases of large, invasive ameloblastoma.

The goal of the expert oral surgeons at The Oral Cancer Institute is to ensure the complete removal of the tumor to prevent recurrence.

Jaw Reconstruction Surgery

After the affected portions of your jaw are removed, your oral surgeon will repair your jawbone and ensure that your facial bone structure appears normal and symmetrical.

Some techniques your surgeon may use to reconstruct your jaw include:

• Free Flaps. Tissue and bone may be taken from your fibula (lower leg bone) or iliac crest (hip bone) to re-create your jaw.
• Bone grafts. Tissue may be taken from another part of your body or from a donor bone bank to repair your jaw.
• Plates and screws. Hardware is used to attach the new material to the donor site.
• Soft tissue reconstruction. Soft tissue flaps are placed over the new bone to restore the oral mucosa.

The type of reconstruction you’ll need depends on the size, location, and aggressiveness of the ameloblastoma. The oral surgeons at the Oral Cancer Institute have expertise in the treatment of all types of oral tumors as well as jaw and facial reconstruction. You are in good hands!