Ameloblastoma in the Hong Kong Chinese. Part 2: systematic review and radiological presentation

Objectives: The aim of this part of the study was to determine the radiological presentation on conventional radiographs of central ameloblastomas in the Hong Kong Chinese and compare them with other reported series by a systematic review (SR). Methods: The study had two elements, that of a complete series of all ameloblastomas presenting at a major Chinese maxillofacial surgical unit and a SR. The files of the Department of Oral and Maxillofacial Surgery of the University of Hong Kong between 1989 and 2000 were reviewed for ameloblastoma cases. The relevant literature was identified by electronic databases, review of citation lists and handsearching of key journals. The principal selection criterion was that the study should represent a complete collection of cases. Results: Only 13 reports gave any radiological details. The present study of the Hong Kong Chinese contained 61 cases. With the exception of radiodensity and shape of radiolucency, the majority of the 13 other reports did not record the other radiological features that could be important in the diagnosis. The present study agreed with the synthesis of the 13 reports with regards to complete radiolucency and cortication of ameloblastomas, but disagreed with regards to other important features. The present study had a significantly higher proportion of unilocular lesions, better marginal definition, and more frequent perforation of the cortex and buccolingual expansion. Nine of the ten maxillary lesions straddled both anterior and posterior sextants with four crossing the midline, whereas only 13 of the 51 mandibular cases affected both sextants, of which eight crossed the midline. The unicystic form, which was most prevalent, appeared significantly more frequently as unilocular radiolucencies in comparison with the non-unicystic forms. The frequencies of unicystic forms and unilocular presentations were significantly greater in the young. The lesions in the young were significantly sited solely in the posterior sextant. The lower border of the mandible was reached and affected by ameloblastoma in 36 cases in the present report. It was displaced and thinned in 15 cases whereas in just five it was at least partially undisplaced with the lesion expanding down past it either buccally or lingually to it. The unicystic form was significantly more associated with root resorption, tooth displacement and crowns of unerupted teeth. Conclusions: Radiologically, ameloblastomas in the Hong Kong Chinese differ significantly with regards to many features. This can be in part explained by the higher proportion of the unicystic form

Ameloblastoma in the Hong Kong Chinese. Part 1: systematic review and clinical presentation

Objectives: The aim of Part 1 of this study was to determine the clinical presentation of central ameloblastomas in the Hong Kong Chinese and to compare them with other reported series by a systematic review (SR). Methods: The study had two elements, that of a complete series of all ameloblastomas presenting at a major Chinese maxillofacial surgical unit as well as a SR. The files of the Department of Oral and Maxillofacial Surgery of the University of Hong Kong between 1989 and 2000 were reviewed for ameloblastoma cases. The relevant literature was identified by electronic databases, review of citation lists and hand searching of key journals. The principal selection criterion was that the study should represent a complete collection of cases. Results: Fifty-three published series of cases were included in the SR. They generally reported little more than sex, mean age and range, and affected jaw. Only 16 studies considered recurrence. Sixty-one cases of ameloblastoma were identified in the present study. There were 30 males and 31 females, contrary to the predilection for males in other reports. Eighty-four percent of cases were found in the mandible, agreeing with the SR. The mean age at first presentation was 30.5 years, lower than that of the SR; only a Korean report and a small Bangladeshi report showed younger presentation. The present report had the shortest period between first becoming aware of the lesion and seeking treatment; this period was significantly shorter for younger patients. Although the present study was in agreement with the SR with regard to swelling, this study reported a significantly higher proportion of patients presenting with pain. Conclusion: Although the presentation of ameloblastoma within this Chinese community was broadly similar to that observed in other populations, it differed in a number of important respects. It had a younger age at first presentation than many other communities, including other Orientals; it was associated with a shorter period between first becoming aware of the lesion and seeking treatment, particularly in the young; and it was more frequently associated with pain than in the SR