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Table of Contents   
SHORT COMMUNICATION  
Year : 2013  |  Volume : 24  |  Issue : 6  |  Page : 782-783
Ultrasonographic evaluation of intramandibular ameloblastoma


1 Oral and Maxillofacial Surgery Group- Albert Einstein Israeli Hospital, Vila Penteado General Hospital, Sao Paulo, Brazil
2 Oral and Maxillofacial Surgery Group- Albert Einstein Israeli Hospital, Vila Penteado General Hospital; Dental School, University of Sao Paulo, Brazil
3 Mandaqui General Hospital, Sao Paulo, Brazil
4 Ermelino Matarazzo Hospital, AME-Itapevi, OSS Santa Catarina, Sao Paulo, Brazil

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Date of Submission18-Jul-2009
Date of Decision17-Sep-2000
Date of Acceptance22-Jul-2010
Date of Web Publication20-Feb-2014
 

   Abstract 

Ultrasonography (US) is the diagnostic tool of choice for evaluating soft tissue lesions in the head and neck region. It is an economic, noninvasive, easily performed exam and provides real-time images, without the exposure to ionizing radiation, and contrast media is not required. It is usually believed that bone tissue constitutes an obstacle for its utilization, due to the reflection of sonographic waves. A case of mandibular intraosseous cystic pathology is reported, with utilization of US for evaluating the content of the lesion and planning the surgical procedure.

Keywords: Ameloblastoma, odontogenic tumors, ultrasound diagnosis

How to cite this article:
Shinohara EH, Kaba SP, Martini MZ, Hueb CH. Ultrasonographic evaluation of intramandibular ameloblastoma. Indian J Dent Res 2013;24:782-3

How to cite this URL:
Shinohara EH, Kaba SP, Martini MZ, Hueb CH. Ultrasonographic evaluation of intramandibular ameloblastoma. Indian J Dent Res [serial online] 2013 [cited 2019 Nov 19];24:782-3. Available from: http://www.ijdr.in/text.asp?2013/24/6/782/127636

   Case Report Top


A female patient exhibiting an asymptomatic lytic lesion in the left mandibular body was evaluated. The panoramic radiography revealed a cystic image, completely involving the lower third molar [Figure 1]. The presumptive diagnosis was of unicystic ameloblastoma or odontogenic keratocyst. US was then performed, which showed an intracystic anechoic image (compatible with cystic content), another large hyperechoic image (compatible to the tooth), and a last hypoechoic image attached to the internal bone cortical (suggesting an epithelial proliferation) [Figure 2]A-B. The US image was consistent with the hypothesis of unicystic ameloblastoma. Based on the clinical aspect and evolution of the lesion, total enucleation was performed and a histopathologic confirmation of the hypothesis was obtained. The patient is still under follow-up for 4 years, without any signs of recurrence [Figure 3].
Figure 1: Cystic image in the left mandibular body

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Figure 2: Ultrasonographic aspect of the lesion. Note the hyperechoic signal (A) showing the image of the tooth. The hypoechoic signal (B) compatible with the epithelial proliferation

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Figure 3: Radiographic aspect after 4 years of surgical enucleation

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   Discussion Top


The restriction to the use of US in the bony tissue is accepted, but we may consider that in mandibular cystic tumors (also in solid ameloblastomas), a liquid content may exist. [3] Thus, sonographic waves are able to pass cortical bone that was thinned as result of the expansion of the lesion, allowing the cystic content to be evaluated without violating cystic walls. In cases of small intrabony lesion, this technique is not indicated, because ultrasonic waves cannot penetrate thick bone walls. In all cases of mandibular cystic lesions we perform US, even when there is an ameloblastoma suspect (cystic or solid). US allow us to identify the ideal areas ( as epithelial lining thickening) for executing biopsies. [3] In this case a simple enucleation was the treatment of choice without performing a incisional biopsy first considering that the treatment would be the same regarding the histopathologic pattern. Most of mandibular cystic lesions cause cortical expansion and consequent thinning, facilitating the passage of the ultrasonographic waves. The main advantage of US over simple orthopantomography is that US is a dynamic exam that allows to check the interior of the lesion, detecting areas of tissue proliferation, including biopsy areas. [3] Bone corticals thinner than 1 mm may allow the passage of the ultrasonographic signal. The color Doppler flow imaging system was not used because vascular pathology was not suspected at any time. In the present report, a 7.5 MHz transductor was used with a GE® Logic-400 device. Thus, US may be used for evaluating the content of mandibular cystic lesions.


   Acknowledgment Top


To FUNDUNESP-Foundation for the development of UNESP (Universidade Estadual Paulista).

 
   References Top

1.Schon R, Duker J, Schmelzeisen R. Ultrasonographic imaging of head and neck pathology. Atlas Oral Maxillofac Surg Clin North Am 2002;10:213-41.  Back to cited text no. 1
    
2.Lu L, Yang J, Liu JB, Yu Q, Xu Q. Ultrasonographic evaluation of mandibularameloblastoma: A preliminary observation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:e32-8.  Back to cited text no. 2
[PUBMED]    
3.Shinohara EH, Horikawa F. Cysts: Liquid content. Br Dent J 2005;199:587.  Back to cited text no. 3
    

Top
Correspondence Address:
Elio Hitoshi Shinohara
Oral and Maxillofacial Surgery Group- Albert Einstein Israeli Hospital, Vila Penteado General Hospital, Sao Paulo
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.127636

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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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