The Clinical And Fundamental Research Of Ameloblastoma Treated By Marsupialization

Ameloblastoma（AM）is an odontogenic tumor which accounts for about 1%of head and neck tumors^[1].Ameloblastomas mostly occur in the jaws especially in the third molar area in the mandible.It will often resulting in enlargement of the jaws and facial deformation^[2].This tumor mainly contains enamel-like structures,but no enamel or other hard tissue was formed.Although it is a benign tumor,its growth still has local invasive,and the recurrence rate is high.There are also reports of malignancy and even distant metastasis^[3].Although it is a benign disease,it is often referred to as a"critical tumor"because of its high recurrence and local invasiveness.In 1879Falkson first described the disease and was officially named as ameloblastoma by Churchill in 1929.Ameloblastoma is furtherclassified into:Solid/multicystic;Extraosseous/peripheral;Desmoplastic ameloblastoma and Unicystic by the WHO organization.Traditional treatment of amloblastoma was“conservative’’and‘‘radical,that is to remove cysts and cure them.However,this method is very traumatic for patients,especially for those patients with large cysts that are already on the verge of forming pathological fractures.The radical surgery will directly affect the function and beauty of patients with facial and occlusion.Marsupialization or decompression as a new treatment method for jaw cysts brings a lot of convenience to patients.Marsupialization can not only treat the lesions of the jaw cysts,but it retained the jaw tissue as much as they can.And it can also reduced the postoperative deformity,and lower the economic burden for the patient.The study group is compared of ameloblastoma patients（n=9）diagnosed and treated between 2010 and 2017.All the patients were came from School of Stomatological,Jilin University,Changchun 130021,Jilin Province,China.Comparing the preoperative image slices with the imaging images of multiple postoperative reexaminations,a comparative study was conducted based on the changes in the maximum diameter of the cysts in the measured surface faults.At the same time,the histological pathological blocks from surgery after decompression at the first time and blocks from surgery after second decompression treatment（or radical surgery）were HE staining and immunohistochemical staining.Ki-67,PCNA and CAV-1 was chosen to have immunohistochemical staining.Counting was performed using Image-Pro Plus（IPP）program and SPSS22.0 statistical software was used for paired t-test statistical analysis.Follow-up for the shortest 5 months and the longest 47 months,collected imaging data of the patient（contour tomography and CT of the jaws）and immunohistochemical staining of the pathological wax mass,and compared the reduction of the lesion area in the image.Correlates with decompression for the treatment of ameloblastoma prognosis.6 patients who had a good result after decompression the expression of Ki-67,PCNA and CAV-1 proteins before treatment was significant changed after decompression（P<0.05）.There were no changes between 3patients who had a bad result after decompression the expression of Ki-67,PCNA and CAV-1 proteins after decompression（P>0.05）.Result:1.Decompression is a safe,effective and reliable treatment for ameloblastoma.2.Changes in pressure inside and outside the cyst cavity after windowing,resulting in changes in the microenvironment of the cyst may have implications for epithelial hyperplasia3.Changes in pressure inside and outside the cyst cavity after windowing,resulting in lower expression of Ki-67 and PCNA,higher expression of CAV-1,thus decreased the invasion property and had a good prognosis.