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Adamantinum of the upper and lower jaw

 

A very rare disease - adamanthoma - is a malignant formation of the bone system. The specificity of adamanthinoma is that this tumor originates from cellular enamel structures. The disease at this time is still at the stage of study, as in its etiology there are still many controversial and obscure points.

Epidemiology

Adamantinum is considered a very rare malignant tumor (in 0.15% locally malignant). According to statistical data, the frequency of detection of adamanthinoma varies from 0.3 to 0.48% of all registered oncological bone pathologies.

Men with adamanthoma predominate, 50-60 years old. However, cases were described when the disease was detected in women aged 25-35 years, and even in newborns.

The primary localization of adamanthinoma is the area of the lower jaw (in 90% of patients). But in some cases, the pathology was recorded in the tibia.

Causes of the adamanthins

The reasons for the appearance of a tumor are still a mystery to scientists. There is still no definitive answer. There are only assumptions to which the authors of scientific works are inclined.

Some experts believe that adamanthinoma is a consequence of the wrong development of the rudiment of the tooth. Other scientists insist that the origin of adamanthinoma is associated with the epithelial structures of the mucous tissues of the oral cavity. The third group of specialists is sure that the tumor originates from the odontogenic islands of Malassé - the elements of the epithelium.

In addition, there is a fourth version - the appearance of adamanthinoma from the layer of the epithelium of the follicular cystic formations.

Since the causes of the appearance of the tumor are unknown, many risk factors are also being questioned. Previously, it was assumed that the disease can be caused by tissue trauma, or their damage due to any extrinsic pathologies.

Pathogenesis

Previously, the disease was identified with endothelioma, and only since 1913 the pathology has been described as an independent disease (at that time it was a question of primary adamantine of the tibia). Then the doctors assumed the theoretical emergence of a tumor from the embryonic epithelial tissue of the dentin embryo. This version existed long enough - until the scientists pointed out the possible histogenesis of the neoplasm.

In the 30's. In the last century adamanthinum was included in the primary epithelial formations. However, this did not put an end to the pathogenesis of the disease. After 10-20 years, the specialists described the cases when adamanthinum appeared in the bones against the background of fibrous dysplasia. As a result, the theory of the origin of the tumor began to divide even more diametrically: presumed a vascular etiology, a variant of angioblastoma,

At the moment, the pathogenetic mechanism is not fully understood. The majority of specialists have settled on the fact that it is most logical to classify adamantine as endothelioma, since these tumors have a similar structure. Carrying out careful electron microscopy, scientists pointed to the complex cellular structure of the tumor, and its histology is variable, which adds problems in the description of the tumor.

Symptoms of the adamanthins

The development of adamanthamines is usually slow, gradual, painless.

The first signs can be expressed in the appearance of edema or a slight swelling. However, as practice shows, the beginning of the development of edema and seeking medical help can take several years (and even several decades).

In isolated cases, adamanthinum develops rapidly, rapidly, accompanied by pronounced local and general signs, with the spread of metastases through the blood and lymph.

If adamanthoma develops in the area of the mandible, then over time, there is a facial deformation, the patient begins to experience difficulties with speech, swallowing, chewing, painful sensations appear. If the tumor reaches a large size, then the development of bleeding, ulceration of the mucosa, the appearance of pathological fractures of the jaw bones.

The adamantine of the lower jaw is more often localized in the region of the angle or branch. In most cases, it resembles a cyst, but does not have a clearly marked capsule. If such "cysts" are located multiple, then they unite, transforming into larger entities. Usually this tumor is gray, elastic, supple. In the cavities of the neoplasm, there is yellow matter (sometimes - a colloidal consistency). The bone tissue surrounding adamantine is distinguished by its subtlety. The tumor can grow deep, leading to deformation of the bones of the face.

Adamanthinoma of the tibia develops with the formation of a significant spilled destructive focus. In some cases there is a fusion of several globular foci, sometimes pathological breaches of bone integrity are detected. Typical is the appearance of primary destructive changes in the cortical layer of the long bone, followed by its destruction and damage to the cavity of the bone marrow and diaphysis.

Adamantinum of the upper jaw is extremely rare - only in isolated cases. If the upper jaw is injured, the patient may experience difficulty with nasal breathing. Sometimes there are disorders of vision in the form of double vision, increased teardrop. The sensitivity of the skin in the upper half of the face may be impaired. Some patients note the appearance of aching pains, the type of usual toothache. Deformation of the face with maxillary localization is not observed.

Stages

According to the structural type, there are two types of adamanthinoma: solid and polycystic. In fact, these species do not belong to independent forms, but proceed one after another.

A solid view of adamanthinoma is the initial stage of the neoplasm, which develops at a more accelerated pace, in contrast to the polycystic variant. Solid adamantinoma is a nodal formation of various densities, with a grayish or reddish hue, with or without a capsule.

Polycystic adamanthinoma is a combination of several cystic formations that contain a light or brown discharge within them. Microscopically one can detect the presence of typical branched epithelial strands or inclusions with interlayers of connective tissue, with blood and lymphatic vessels. Stellate cell structures are in the central part of the complex epithelium.

The described staging has much in common with structural changes in the growing enamel dentition.

There is another - the histological classification of adamanthinoma:

  • granular cell tumor;
  • basal cell carcinoma;
  • Acanthomatous (keratin) tumor;
  • pleomorphic tumor (with the presence of epithelial cords);
  • a follicular tumor.

Complications and consequences

Adamantmoma is often complicated by inflammatory diseases that lead to the formation of ulcers and fistulas with serous or purulent discharge that go into the oral cavity. Trauma and mechanical damage to the neoplasm can provoke the development of a purulent inflammatory process or purulent osteomyelitis of nearby bone tissue. Bone melting and the destructive processes of osteolysis, which are the result of infiltration, can cause a pathological bone fracture.

Local malignant adamanthinoma can be transformed into a full-fledged malignant process, with the spread of metastases by lymphogenous and hematogenous pathways. This happens in about 4.5% of cases: most often this complication affects patients who did not receive the necessary treatment in a timely manner.

Diagnostics of the adamanthins

Adamantine in the jaw is found when examining the oral cavity by a dentist. The diagnosis is made on the basis of the results of the examination, questioning the patient, in the presence of characteristic complaints.

Instrumental diagnosis involves the use of radiography, which is carried out in different projections: it is panoramic, intracavitary, lateral and axial projections. The obtained images allow to estimate the magnitude and stage of the morbid focus, as well as the state of the damaged bone.

The main typical radiographic signs of adamanthinoma are:

  • the presence of a solid tumor, which has the form of small dark nodules, divided by bone membranes;
  • presence of a cystic tumor, with sites of destruction or with affected zones, divided by bone membranes;
  • edema or mandibular mandibular deformation;
  • sclerosis and thinning of the mandibular bones;
  • destructive changes in the alveolar process, deformity and violation of the planting of the dental roots (not in all cases);
  • destructive processes in the angular portion of the lower jaw, right up to the coronoid process.

The affected area can be small in size, or spread to significant areas of tissue: the doctor will notice this during the study.

An important component of the diagnostic process in adamantine is the confirmation or exclusion of the oncological nature of the disease. For this, the doctor will make a puncture of the tumor. Further analyzes are performed with the cytology of the selected fluid. In a benign process, the analysis will indicate the presence of fibrin, blood cells, cholesterol, lipid-granular and stellate cells.

What do need to examine?

Differential diagnosis

Differential diagnosis of adamanthinoma is carried out with inflammatory dentokistami, carcinoma and salivary gland cyst, with osteoblastoklastoma and other tumor formations.

Who to contact?

Treatment of the adamanthins

It is possible to completely cure adamantine only surgically. If the disease is accompanied by purulent processes, then an antibacterial treatment with oral sanitation is preselected.

Surgical treatment for adamanthinoma may be different - it depends on the size of the lesion and the extent to which the process has spread to nearby tissues. If the pathology was detected at the initial stage of development, the removal can be performed without changing the integrity of the jaw - this treatment is more acceptable, since it allows to maintain its functionality to some extent. In surgical intervention after tumor tumor is excavated, the cavity walls are washed with a phenolic solution. This makes it possible to induce necrosis processes in the remaining epithelial tissues, which serves as the prevention of the recurrence of adamanthinoma.

If the tumor has grown to a considerable extent, the surgeon conducts its removal, partially affecting the integrity of the jawbone. When removing a large area of bone tissue, it is possible to use bone plasty with the use of orthopedic structures.

Treatment of adamanthinoma after surgery involves taking antibiotics, physiotherapy and diet with the exception of rough and dense food.

The rate of recovery of the body in the postoperative period depends both on the regular performance of the doctor's appointments, and on compliance with the general rules of rehabilitation.

For 24 hours after the operation, the patient must ensure complete rest with bed rest. Rest and full sleep will help the body to recover faster. To remove postoperative edema and pain, cold compresses can be used. They are applied for about 15 minutes.

If the operation was performed on the jawbones, then for a while the patient will be prescribed a diet, using only the rubbed and liquid food. If adamanthinoma was removed from other bones, then the rehabilitation scheme is prescribed by the doctor individually, taking into account the patient's condition and his motor abilities.

Medications

What medications should be taken after the operation to remove adamanthinoma, and in what quantities, only the treating doctor should determine. Most often the doctor can recommend the reception of vitamin complexes (vitamins A, E and C are especially important). The simplest and most affordable drugs in this category are ascorbic acid tablets, Aevit capsules, Undevit and Gexavit. Any disease, including adamantimon, proceeds with a decrease in the body's defenses. If timely measures are taken and immunity strengthened, it is possible not only to prevent the development of complications, but also to prevent the recurrence of neoplasm development. Medical appointments of a doctor during rehabilitation should necessarily include vitamins - to support the body and strengthen its internal protective reserves.

Antibiotics and sulfanilamides are used to prevent the development of infection, as well as to eliminate signs of inflammation in damaged tissues. Among such medicines the most popular are Ciprofloxacin, Ampicillin, Ethazol, Sulfazin.

In addition, the doctor may prescribe drugs that improve blood circulation: Nicotinic acid, Trental, Pentoxifylline.

Nonsteroidal anti-inflammatory drugs can help relieve pain and stabilize body temperature. The most popular drugs in this category are Diclofenac, Ibuprofen, Acetylsalicylic acid.

Dosing and Administration

Side effects

Special instructions

Ciprofloxacin

Assign inside by 0,125-0,5 g twice a day, for 1-2 weeks.

Rarely - allergies, changes in taste, pain in the abdomen, diarrhea.

Tablets can not be washed down with alkaline mineral water.

Sulfazin

Take 1-2 g daily, until the patient's condition is normalized.

Sometimes - nausea, vomiting, hematuria.

The drug is not recommended for pregnancy.

Pentoxifylline

Take inside, 2 tablets (0.2 g) three times a day after eating, without chewing. Duration of treatment - 2-3 weeks.

Headache, sleep disturbance, pain in the heart, indigestion.

The drug is contraindicated in pregnancy, as well as for the treatment of children under 12 years.

Ibuprofen

Assign in tablets of 200 mg to 4 times a day, preferably not more than five days.

Abdominal pain, ringing in the ears, dizziness, sleep disturbance, allergies.

The drug is used in short courses, with the control of the digestive system.

Physiotherapeutic treatment

Physiotherapy methods - this is an important addition to the conservative treatment of adamantinoma in the postoperative period. Physiotherapy will help reduce the intensity of inflammation, calm pain and prevent the development of infection in the wound.

As a rule, doctors recommend paying attention to such types of treatment:

  • ultraviolet irradiation of the mucosa with the use of a short or integral radiation spectrum, starting with 2 biodosises, gradually bringing up to 5-6 biodos (for courses - up to 6 sessions);
  • ten-minute fluctuorization in the amount of five to six sessions;
  • CMV-therapy from 5 to 7 minutes per procedure;
  • electrophoresis with anesthetics (with pain sensations), for example, with trimecaine;
  • magnetotherapy pulsating magnetic field with a pulsed mode (1: 1, or 1: 2), for 25-30 minutes, in an amount of 12-16 procedures.

Alternative treatment

As a supplement to standard medications in adamantine, the doctor can recommend tonic and analgesic prescriptions for alternative medicine. For example, these are:

  • With tibial adamantine, a compress is applied with a white acacia-based medicine: mix the acacia flowers with table salt in a ratio of 10: 1, stand for at least three hours and apply as a compress to the affected area. Do not put such a compress if the skin is damaged - has cracks, scratches, cuts.
  • With adamantine help to ease the condition of tincture of horse chestnut. The color of the plant is filled with vodka in a ratio of 1: 1, withstand 20 days in a dark place. Take the infusion inside 5 ml three times a day before meals, for a month.
  • To restore after the operation to remove adamanthinam use a drink: mix 50 ml of fresh St. John's wort juice with 200 ml of milk, drink in the morning on an empty stomach.
  • In the postoperative period it is useful to drink compote from sour apples - for example, from "antonovka". To make it, three medium-sized apples are sliced, poured into water, brought to a boil, removed from the fire and covered with a lid. After three hours you can drink a drink, preferably on an empty stomach.

Herbal Treatment

In the treatment of adamanthinoma of the jaw, mouth rinsing is considered an important procedure that helps to get rid of a possible infection, reduce pain, prevent and prevent inflammation. The use of decoctions and herbal infusions successfully complements the traditional treatment prescribed by the doctor.

To facilitate the condition with adamantine, plants such as sage, chamomile, calendula, thyme, hyssop, horsetail, eucalyptus leaves, thyme, yarrow have a good effect. In order to prepare a curative infusion, two tablespoons of herbal raw material is poured into 200 ml of boiling water, allowed to stand and filtered. The resulting infusion is used to rinse the oral cavity - the more often, the better.

A wonderful anti-inflammatory and antiseptic ability is possessed by sage. To prepare a medicine 1 tbsp. L. The plants are boiled for 20 minutes in 200 ml of boiling water. The broth is used for rinsing.

To increase the effectiveness of the above-proposed remedy, it is possible to add a little crushed killer whale to it.

Rinse should be done at least 10 times a day. Infusions need to be cooked every day, no matter how fresh. The rinse liquid should not be hot: the optimum temperature is about 36-37 ° C.

Homeopathy

The appointment of homeopathic drugs is carried out on an individual basis, taking into account the characteristics of the patient and the stage of the disease.

After the operative removal of adamantinum, the patient's condition usually improves after taking Arnica or Hypericum.

Hin is recommended for postoperative bleeding.

In the presence of an inflammatory process, Mercury solubilis, Nuks Vomica, Phosphorus, Lachezis can help.

As a rule, drugs are prescribed in low dilutions, taking into account that the lower the dilution, the more often the drug is taken.

Preparations are taken before meals, about half an hour. In addition, you can not brush your teeth and eat chewing gum immediately before and after taking homeopathic remedies.

Prevention

Specific methods of prevention of adamanthinoma do not exist, therefore it is very difficult to prevent the appearance of pathology in advance. It is recommended periodically, at least once every six months, to consult a dentist about a preventive examination. You also need to see a doctor at the first signs of oral disease.

If possible, mechanical damage to bones, bruises, and strokes should be avoided. When installing dentures, it is necessary to select high-quality materials, and the installation itself must be trusted only by an experienced specialist.

Forecast

The prognosis of adamanthinoma is positive in most cases. But - provided timely detection and removal of tumors.

However, it should be borne in mind that adamanthinoma has a considerable propensity to re-develop, so the patient is subject to clinical follow-up after the operation.

Last update: 26.06.2018
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Medical expert editor

Portnov Alexey Alexandrovich

Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"

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