Tumors of the Pediatric Maxillofacial Skeleton

Abstract

Pediatric jaw tumors are rare lesions most commonly presenting with a swelling or mass. Patients can be asymptomatic with the lesion identified on routine imaging. Certain clinical features such as age, location of tumor, and presence or absence of bone and soft tissue can narrow the differential diagnosis and identify tumors that may be malignant. Incisional biopsy is an important first step. A majority of jaw tumors are benign but require surgical intervention for eradication of disease. Multiple procedures, including reconstruction, may be required for certain lesions prior to cure.

Management of ameloblastoma in the pediatric population

“…The radical approach includes surgical resection with a clear margin of uninvolved bone and soft tissue. 13 Solid and multicystic tumors are aggressive with recurrence rates of 75-90% after conservative management. 1,14 Radical surgical treatment is therefore advocated and has been shown to improve outcomes.…”

“…1,14 Radical surgical treatment is therefore advocated and has been shown to improve outcomes. 13,15 In their 2006 paper, Carl and Marx advocated radical surgical resection with a 1 to 1.5cm margin after finding that the tumors extended 2 to 8mm beyond their radiographic demarcation on histopathological evaluation. Using this approach, a review of 82 ameloblastoma resections showed no recurrence after 5 years.…”

“…18 The exception is for the intraluminal and intramural subtypes where aggressive surgical resection is advocated. 2,5,13 Peripheral ameloblastomas are often clinically innocuous and respond well to local surgical excision. Recurrence rates of 15-20% have been described, though treatment with further local resection usually results in a cure.…”

“…25 Techniques described for reconstruction include bone grafting, plate fixation, autogenous rib graft placement, or microsurgically revascularized bone transplants based on age and extent of defect. 10,11,13,21,22 More recently, attention has been turned towards primary reconstruction especially with regards to mandibular defects in children due to quality of life considerations. Traditionally, these defects were bridged with rigid plates and screws while awaiting secondary reconstruction.…”

“…Lip numbness and contour defects of the face have also been reported. 10,13 Close follow up with radiographic surveillance is crucial following treatment of ameloblastoma.…”