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Unsuspected Ameloblastoma: Report of Case
Unsuspected am eloblastom a: report of case
John J. Tarsitano, DDS, MS, W iesbaden, Germany
d e fin a b le
Philip J. Holmes, DDS, Dayton, O hio
t w e e n th e a p e x e s o f th e r ig h t la te r a l in c is o r , c a
s m a ll n in e ,
s o ft
s h re d s and
tis s u e
n o s is
w as
a
h o s p ita l
o ra l
s u rg e ry
s e rv ic e
fo r
e v a lu a t io n
cyst
w e re
Som e
fro m
be
s u b m itte d
P r o v is io n a l d ia g
or
tr a u m a tic
(h e m
w a s p la c e d s e c o n d b e c a u s e th e p a t ie n t ’ s a g e a n d th e
lo c a tio n
w ith
th is
o f th e
e n tity .
le s io n
The
w e re
n o t c o n s is te n t
p a th o lo g is t r e p o r t e d
t h e tis s u e w a s c o n s is te n t w it h
th a t
a p e r ia p ic a l, r a
d ic u la r , o r r e s id u a l c y s t ( F ig 3 ). I n J u ly
M a y o f 1 9 7 0 , a 5 0 -y e a r -o ld m a n w a s s e e n a t
and
e x a m in a tio n .
p e r ia p ic a l
seen.
s c ra p e d
o r r h a g ic ) c y s t . T h e d ia g n o s is o f t r a u m a t ic c y s t
1 9 7 0 , th e p a tie n t r e tu r n e d f o r f o llo w -
u p e x a m in a tio n In
w as
w e re
fir s t p r e m o la r ,
f o r m ic r o s c o p ic
A p a th o lo g is t reported an excised cystic lesion to be n o n m a lig n a n t. D uring the next tw o years, the p a tie n t received extensive fo llo w -u p care, b u t co m plained o f pain and sw e llin g in th e m andible. He was referred fo r treatm ent. At th a t tim e, pa n o ra m ic ra d io g ra p h s show ed a m u ltilo c u la r ra d io lu c e n t area in th e a n te rio r m andible.
lin in g
o f tis s u e
a t w h ic h
tim e th e r ig h t c e n tr a l
a n d la t e r a l in c is o r s a n d c a n in e w e r e te s te d a n d fo u n d
n o n v ita l.
S in c e th e p a t ie n t liv e d
s e v e ra l
o f a le s io n o f th e a n t e r io r m a n d ib le . P a n o r a m ic
h u n d r e d m ile s f r o m th e h o s p ita l s e r v ic e , h e w a s
r a d io g r a p h s r e v e a le d a m u lt ilo c u la r r a d io lu c e n t
a d v is e d
a r e a in t h e r ig h t a n t e r io r m a n d ib le ( F i g
v ic e c lo s e r t o h is h o m e .
1 ). T h e
to
seek
e n d o d o n tic
a n d fo llo w -u p
s e r
p a t ie n t w a s w it h o u t s y m p to m s , a n d a ll m a n d ib u
T h e p a t ie n t r e t u r n e d t o h is h o m e a n d s o u g h t
la r a n t e r io r te e th b u t th e r ig h t c a n in e r e s p o n d e d
f o llo w - u p c a r e . H e w a s e x a m in e d in D e c e m b e r ,
to e le c t r ic p u lp te s tin g .
in
W ith
th e
p a tie n t u n d e r lo c a l a n e s th e s ia , th e
M a rc h ,
June,
S e p te m b e r,
N o v e m b e r,
and
D e c e m b e r o f 1 9 7 1 , a n d in F e b r u a r y a n d A p r i l o f 1 9 7 2 . D u r i n g th is p e r io d
th e m a x illa r y
c a v it y w a s f ille d w ith a y e llo w is h flu id , a n d n o
fir s t
p r e m o la r w e r e
Fig 1 ■ Panoramic radiograph taken in May 1970.
Fig 2 ■ Extent of lesion at time of first surgery (May 1970).
a re a
898
w as
exposed
and
e x p lo r e d
• JADA, Vol. 87, October 1973
(F ig
2 ).
The
m o la r a n d
le ft s e c o n d
r ig h t re -
Fig 3 ■ Photomicrograph of biopsy specimen (May 1970). Diag nosis based on compressed stratified squamous epithelium. Hematoxylin and eosin. Magnification x40.
Fig 5 ■ Panoramic radiograph taken in May 1972. Compare size of lesion with that in original radiograph (Fig 1).
e x p lo r e d .
The
c a v it y
w as
fille d
w ith
a
s tra w -
c o lo r e d f lu id a n d a la r g e p ie c e o f fib r o u s tis s u e w a s a tta c h e d s u p e r io r ly in th e a r e a o f th e m a n d ib u la r r ig h t c a n in e a n d i n f e r i o r l y in t h e a r e a o f th e
m a n d ib u la r le f t la t e r a l in c is o r .
T h is
tis s u e
w a s n o t p a r tic u la r ly a d h e r e n t a n d w a s s u s p e n d e d in Fig 4 ■ Postoperative periapical radiographs taken June 1971 (left), December 1971 (center), and February 1972 (right).
a
s lin g lik e m a n n e r . T h e
s to r e d , a n d h e w a s g iv e n o r a l p r o p h y la x e s a n d d e n tis tr y
c o u n s e lin g .
d io g r a p h s w e r e ta k e n
P e r ia p ic a l r a
o f th e a n t e r io r m a n d ib le
in J u n e a n d D e c e m b e r o f 1 9 7 1 , a n d in F e b r u a r y M a y , th e p a tie n t w a s
ic a l c e n te r .
The
r e fe r r in g
re fe rre d
to
a m ed
d e n tis t w r o t e ,
“ Pa
t ie n t g iv e s h is t o r y o f c y s tic a r e a s in l o w e r r ig h t a n t e r io r m a n d ib le . C y s t w a s r e m o v e d M a y 1 9 7 0 . R o u tin e show
X -ra y
little
th e
m a n d ib u la r
le ft
and
r ig h t
fir s t a n d s e c o n d p r e m o la r s , c a n in e s , a n d la te r a l and
c e n tr a l in c is o r s
w e re
re m o v e d
a lo n g
w ith
a ll th e a lv e o la r p r o c e s s in v o lv e d w it h th e le s io n . T h e b o n y w o u n d m a r g in s w e r e e x te n d e d
1 cm
b e y o n d th e b o r d e r s o f t h e tu m o r . T h e le s io n h a d
1 9 7 2 ( F ig 4 ). In
sub
w a s d ia g n o s e d a s a n a m e lo b la s t o m a . A c c o r d in g ly ,
p r e v e n tiv e
tis s u e w a s
m itte d t o th e p a th o lo g is t f o r f r o z e n s e c tio n a n d
exam s
change.
o v e r th e p a s t tw o
P a tie n t
now
y e a rs
c o m p la in s
of
p e rfo ra te d
th e
lin g u a l c o r t e x , a n d
th e
s o ft tis
s u e in th is a r e a w a s a ls o g e n e r o u s ly e x c is e d . A l l tis s u e s
w e re
in a tio n
(F ig
r a d io g ra p h
s u b m itte d 6 ).
The
fo r
m ic r o s c o p ic
p o s to p e r a tiv e
( F ig 7 ) r e v e a le d
th e
exam
p a n o r a m ic
e x te n t o f h a rd
t is s u e lo s s .
d u ll p a in a n d s w e llin g in t h e a r e a . P le a s e e v a l u a te
and
re c o m m e n d
tre a tm e n t o r tre a t as re
D iscu ssio n
q u ir e d .” P a n o r a m ic a
la rg e ,
te n d e d
a t th is t im e
r e v e a le d
m u ltilo c u la r r a d io lu c e n t a re a
th a t e x
fro m
r a d io g r a p h s th e
m a n d ib u la r le f t c a n in e
r ig h t s e c o n d p r e m o la r ( F ig
5 ). T h e
to
th e
m a n d ib u la r
T h e o r ig in a l p a th o lo g is t r e p o r t e d th e c y s t to b e n o n m a lig n a n t— a n d
w ith
good
re a s o n — o n
th e
b a s is o f t h e p h o t o m i c r o g r a p h s h o w n i n F i g u r e 3 .
r ig h t c e n t r a l a n d la t e r a l in c is o r s a n d c a n in e d id
T h is
n o t re s p o n d
p a tie n t’ s a n te r io r m a n d ib le ; a r a t h e r r a p id ly e x
re s p o n d e d
to e le c t r ic n o r m a lly .
p u lp
T h e re
te s tin g ; a ll o th e r s w as
no
a p p a re n t
In
J u n e , w it h th e p a tie n t u n d e r s e d a tio n a n d a n e s th e s ia ,
th e
le s io n
w as
v e ile d
th e tr u e c o n d itio n
in
th e
p a n d in g le s io n , a lm o s t a c la s s ic a l a g g r e s s iv e e n t i t y , w a s r e p e a t e d ly in t e r p r e t e d a s n o r m a l h e a l
s w e llin g o r te n d e r n e s s in th e a re a . lo c a l
d ia g n o s is
exposed
and
in g . P e r h a p s in o u r c o n c e r n w it h
th e m e c h a n is m
Tarsitano—Holmes: UNSUSPECTED AMELOBLASTOMA ■ 899
Fig 7 ■ Postoperative panoramic radiograph showing extent of hard tissue loss.
e i t h e r w a x e s o r w a n e s , a n d i f n o t t h e l a t t e r , is s u s p e c t.
A nd
th e
c h r o n o lo g y
is
not
y e a rs
or
m o n th s , b u t w e e k s a n d d a y s !
■ On
a m e lo b la s to m a s : T h e
a m e lo b la s to m a
is
th e m o s t a g g r e s s iv e o f th e o d o n to g e n ic tu m o r s a n d r e p r e s e n ts a b o u t 1 % o f a ll tu m o r s a n d c y s ts o f th e ja w s . P a tie n ts a r e u s u a lly b e tw e e n 2 0 a n d 5 0 y e a r s o f a g e ; t h e r e is n o s i g n i f i c a n t s e x o r r a c e p r e d ile c t io n . A b o u t 8 0 %
o f th e s e tu m o rs o c c u r
in t h e m a n d ib le , p r e d o m in a n t ly in t h e m o la r a n d r a m u s a r e a s , a n d a lth o u g h th e r a d io g r a p h ic a p p e a ra n c e
o f th e
a m e lo b la s to m a
is
v a r ie d
i t is
m o s t c o m m o n ly s e e n a s a m u ltilo c u la te d r a d io lu c e n t a re a
o f bone. A b o u t 25%
to
30%
a r is e
in p r e e x is tin g f o llic u la r c y s ts . T h e tu m o r s g r o w s lo w ly a n d d o n o t m e ta s ta s iz e .1 I n
s p ite o f th e
d e b a te
i t is
c o n c e r n in g
th is
n e o p la s m ,
a g re e d
t h a t a m e lo b la s to m a s a r e u s u a lly u n ic e n t r ic , n o n Fig 6 ■ Photomicrographs of biopsy specimen. Hematoxylin and eosin. Top, many islands of epithelial cells are visible. Magnifi cation, x40. Center, epithelial islands are bordered by segment ed columnar cells that resemble ameloblasts. Magnification, x100. Bottom, note tall epithelial cells with nuclei tending to be basally placed. Structure begins to resemble enamel organ. Magnification, x250.
a n d e v o lu tio n fo rg o tte n
th a t
o f p a th o lo g ic a l le s io n s , w e h a v e th e
p h y s io lo g ic a l
r e s o lu tio n
of
w o u n d d e f e c t s is a n o r d e r l y a n d p r o g r e s s i v e s e quence. tio n
C e r ta in ly
s o c k e t h e a lin g
lie v e
o u r e x p e r ie n c e w o u ld
t h a t le s s t i m e t h a n
have
tw o
w ith le d
us
e x tra c to
900
w o u n d o r le s io n , m e a s u r e d c h r o n o lo g ic a lly , ■ JADA, Vol. 87, October 1973
b e n ig n , a n d c lin ic a lly p e r s is te n t .2
The views expressed herein are those of the authors and do not necessarily reflect the views of the US Air Force or the De partment of Defense. Dr. Tarsitano is a colonel in the US Air Force Dental Corps. His address is USAF Hospital Wiesbaden, Box 305, APO New York, 09220. Dr. Holmes Is a lieutenant colonel in the US Air Force Dental Corps, at the Medical Center, Wright-Patterson AFB, Ohio 45433.
be
y e a r s is r e q u i r e d
t o f i l l in a n i n t r a b o n y d e f e c t . A
fu n c t io n a l, in t e r m it t e n t in g r o w t h , a n a t o m ic a lly
1. Bhaskar, S.N. Synopsis of oral pathology. St. Louis, C. V. Mosby Co., 1961. 2. Robinson, H.B.G. Ameloblastoma: survey of 379 cases from literature. Arch Pathol 23:831 June 1937.
John J. Tarsitano, DDS, MS, W iesbaden, Germany
d e fin a b le
Philip J. Holmes, DDS, Dayton, O hio
t w e e n th e a p e x e s o f th e r ig h t la te r a l in c is o r , c a
s m a ll n in e ,
s o ft
s h re d s and
tis s u e
n o s is
w as
a
h o s p ita l
o ra l
s u rg e ry
s e rv ic e
fo r
e v a lu a t io n
cyst
w e re
Som e
fro m
be
s u b m itte d
P r o v is io n a l d ia g
or
tr a u m a tic
(h e m
w a s p la c e d s e c o n d b e c a u s e th e p a t ie n t ’ s a g e a n d th e
lo c a tio n
w ith
th is
o f th e
e n tity .
le s io n
The
w e re
n o t c o n s is te n t
p a th o lo g is t r e p o r t e d
t h e tis s u e w a s c o n s is te n t w it h
th a t
a p e r ia p ic a l, r a
d ic u la r , o r r e s id u a l c y s t ( F ig 3 ). I n J u ly
M a y o f 1 9 7 0 , a 5 0 -y e a r -o ld m a n w a s s e e n a t
and
e x a m in a tio n .
p e r ia p ic a l
seen.
s c ra p e d
o r r h a g ic ) c y s t . T h e d ia g n o s is o f t r a u m a t ic c y s t
1 9 7 0 , th e p a tie n t r e tu r n e d f o r f o llo w -
u p e x a m in a tio n In
w as
w e re
fir s t p r e m o la r ,
f o r m ic r o s c o p ic
A p a th o lo g is t reported an excised cystic lesion to be n o n m a lig n a n t. D uring the next tw o years, the p a tie n t received extensive fo llo w -u p care, b u t co m plained o f pain and sw e llin g in th e m andible. He was referred fo r treatm ent. At th a t tim e, pa n o ra m ic ra d io g ra p h s show ed a m u ltilo c u la r ra d io lu c e n t area in th e a n te rio r m andible.
lin in g
o f tis s u e
a t w h ic h
tim e th e r ig h t c e n tr a l
a n d la t e r a l in c is o r s a n d c a n in e w e r e te s te d a n d fo u n d
n o n v ita l.
S in c e th e p a t ie n t liv e d
s e v e ra l
o f a le s io n o f th e a n t e r io r m a n d ib le . P a n o r a m ic
h u n d r e d m ile s f r o m th e h o s p ita l s e r v ic e , h e w a s
r a d io g r a p h s r e v e a le d a m u lt ilo c u la r r a d io lu c e n t
a d v is e d
a r e a in t h e r ig h t a n t e r io r m a n d ib le ( F i g
v ic e c lo s e r t o h is h o m e .
1 ). T h e
to
seek
e n d o d o n tic
a n d fo llo w -u p
s e r
p a t ie n t w a s w it h o u t s y m p to m s , a n d a ll m a n d ib u
T h e p a t ie n t r e t u r n e d t o h is h o m e a n d s o u g h t
la r a n t e r io r te e th b u t th e r ig h t c a n in e r e s p o n d e d
f o llo w - u p c a r e . H e w a s e x a m in e d in D e c e m b e r ,
to e le c t r ic p u lp te s tin g .
in
W ith
th e
p a tie n t u n d e r lo c a l a n e s th e s ia , th e
M a rc h ,
June,
S e p te m b e r,
N o v e m b e r,
and
D e c e m b e r o f 1 9 7 1 , a n d in F e b r u a r y a n d A p r i l o f 1 9 7 2 . D u r i n g th is p e r io d
th e m a x illa r y
c a v it y w a s f ille d w ith a y e llo w is h flu id , a n d n o
fir s t
p r e m o la r w e r e
Fig 1 ■ Panoramic radiograph taken in May 1970.
Fig 2 ■ Extent of lesion at time of first surgery (May 1970).
a re a
898
w as
exposed
and
e x p lo r e d
• JADA, Vol. 87, October 1973
(F ig
2 ).
The
m o la r a n d
le ft s e c o n d
r ig h t re -
Fig 3 ■ Photomicrograph of biopsy specimen (May 1970). Diag nosis based on compressed stratified squamous epithelium. Hematoxylin and eosin. Magnification x40.
Fig 5 ■ Panoramic radiograph taken in May 1972. Compare size of lesion with that in original radiograph (Fig 1).
e x p lo r e d .
The
c a v it y
w as
fille d
w ith
a
s tra w -
c o lo r e d f lu id a n d a la r g e p ie c e o f fib r o u s tis s u e w a s a tta c h e d s u p e r io r ly in th e a r e a o f th e m a n d ib u la r r ig h t c a n in e a n d i n f e r i o r l y in t h e a r e a o f th e
m a n d ib u la r le f t la t e r a l in c is o r .
T h is
tis s u e
w a s n o t p a r tic u la r ly a d h e r e n t a n d w a s s u s p e n d e d in Fig 4 ■ Postoperative periapical radiographs taken June 1971 (left), December 1971 (center), and February 1972 (right).
a
s lin g lik e m a n n e r . T h e
s to r e d , a n d h e w a s g iv e n o r a l p r o p h y la x e s a n d d e n tis tr y
c o u n s e lin g .
d io g r a p h s w e r e ta k e n
P e r ia p ic a l r a
o f th e a n t e r io r m a n d ib le
in J u n e a n d D e c e m b e r o f 1 9 7 1 , a n d in F e b r u a r y M a y , th e p a tie n t w a s
ic a l c e n te r .
The
r e fe r r in g
re fe rre d
to
a m ed
d e n tis t w r o t e ,
“ Pa
t ie n t g iv e s h is t o r y o f c y s tic a r e a s in l o w e r r ig h t a n t e r io r m a n d ib le . C y s t w a s r e m o v e d M a y 1 9 7 0 . R o u tin e show
X -ra y
little
th e
m a n d ib u la r
le ft
and
r ig h t
fir s t a n d s e c o n d p r e m o la r s , c a n in e s , a n d la te r a l and
c e n tr a l in c is o r s
w e re
re m o v e d
a lo n g
w ith
a ll th e a lv e o la r p r o c e s s in v o lv e d w it h th e le s io n . T h e b o n y w o u n d m a r g in s w e r e e x te n d e d
1 cm
b e y o n d th e b o r d e r s o f t h e tu m o r . T h e le s io n h a d
1 9 7 2 ( F ig 4 ). In
sub
w a s d ia g n o s e d a s a n a m e lo b la s t o m a . A c c o r d in g ly ,
p r e v e n tiv e
tis s u e w a s
m itte d t o th e p a th o lo g is t f o r f r o z e n s e c tio n a n d
exam s
change.
o v e r th e p a s t tw o
P a tie n t
now
y e a rs
c o m p la in s
of
p e rfo ra te d
th e
lin g u a l c o r t e x , a n d
th e
s o ft tis
s u e in th is a r e a w a s a ls o g e n e r o u s ly e x c is e d . A l l tis s u e s
w e re
in a tio n
(F ig
r a d io g ra p h
s u b m itte d 6 ).
The
fo r
m ic r o s c o p ic
p o s to p e r a tiv e
( F ig 7 ) r e v e a le d
th e
exam
p a n o r a m ic
e x te n t o f h a rd
t is s u e lo s s .
d u ll p a in a n d s w e llin g in t h e a r e a . P le a s e e v a l u a te
and
re c o m m e n d
tre a tm e n t o r tre a t as re
D iscu ssio n
q u ir e d .” P a n o r a m ic a
la rg e ,
te n d e d
a t th is t im e
r e v e a le d
m u ltilo c u la r r a d io lu c e n t a re a
th a t e x
fro m
r a d io g r a p h s th e
m a n d ib u la r le f t c a n in e
r ig h t s e c o n d p r e m o la r ( F ig
5 ). T h e
to
th e
m a n d ib u la r
T h e o r ig in a l p a th o lo g is t r e p o r t e d th e c y s t to b e n o n m a lig n a n t— a n d
w ith
good
re a s o n — o n
th e
b a s is o f t h e p h o t o m i c r o g r a p h s h o w n i n F i g u r e 3 .
r ig h t c e n t r a l a n d la t e r a l in c is o r s a n d c a n in e d id
T h is
n o t re s p o n d
p a tie n t’ s a n te r io r m a n d ib le ; a r a t h e r r a p id ly e x
re s p o n d e d
to e le c t r ic n o r m a lly .
p u lp
T h e re
te s tin g ; a ll o th e r s w as
no
a p p a re n t
In
J u n e , w it h th e p a tie n t u n d e r s e d a tio n a n d a n e s th e s ia ,
th e
le s io n
w as
v e ile d
th e tr u e c o n d itio n
in
th e
p a n d in g le s io n , a lm o s t a c la s s ic a l a g g r e s s iv e e n t i t y , w a s r e p e a t e d ly in t e r p r e t e d a s n o r m a l h e a l
s w e llin g o r te n d e r n e s s in th e a re a . lo c a l
d ia g n o s is
exposed
and
in g . P e r h a p s in o u r c o n c e r n w it h
th e m e c h a n is m
Tarsitano—Holmes: UNSUSPECTED AMELOBLASTOMA ■ 899
Fig 7 ■ Postoperative panoramic radiograph showing extent of hard tissue loss.
e i t h e r w a x e s o r w a n e s , a n d i f n o t t h e l a t t e r , is s u s p e c t.
A nd
th e
c h r o n o lo g y
is
not
y e a rs
or
m o n th s , b u t w e e k s a n d d a y s !
■ On
a m e lo b la s to m a s : T h e
a m e lo b la s to m a
is
th e m o s t a g g r e s s iv e o f th e o d o n to g e n ic tu m o r s a n d r e p r e s e n ts a b o u t 1 % o f a ll tu m o r s a n d c y s ts o f th e ja w s . P a tie n ts a r e u s u a lly b e tw e e n 2 0 a n d 5 0 y e a r s o f a g e ; t h e r e is n o s i g n i f i c a n t s e x o r r a c e p r e d ile c t io n . A b o u t 8 0 %
o f th e s e tu m o rs o c c u r
in t h e m a n d ib le , p r e d o m in a n t ly in t h e m o la r a n d r a m u s a r e a s , a n d a lth o u g h th e r a d io g r a p h ic a p p e a ra n c e
o f th e
a m e lo b la s to m a
is
v a r ie d
i t is
m o s t c o m m o n ly s e e n a s a m u ltilo c u la te d r a d io lu c e n t a re a
o f bone. A b o u t 25%
to
30%
a r is e
in p r e e x is tin g f o llic u la r c y s ts . T h e tu m o r s g r o w s lo w ly a n d d o n o t m e ta s ta s iz e .1 I n
s p ite o f th e
d e b a te
i t is
c o n c e r n in g
th is
n e o p la s m ,
a g re e d
t h a t a m e lo b la s to m a s a r e u s u a lly u n ic e n t r ic , n o n Fig 6 ■ Photomicrographs of biopsy specimen. Hematoxylin and eosin. Top, many islands of epithelial cells are visible. Magnifi cation, x40. Center, epithelial islands are bordered by segment ed columnar cells that resemble ameloblasts. Magnification, x100. Bottom, note tall epithelial cells with nuclei tending to be basally placed. Structure begins to resemble enamel organ. Magnification, x250.
a n d e v o lu tio n fo rg o tte n
th a t
o f p a th o lo g ic a l le s io n s , w e h a v e th e
p h y s io lo g ic a l
r e s o lu tio n
of
w o u n d d e f e c t s is a n o r d e r l y a n d p r o g r e s s i v e s e quence. tio n
C e r ta in ly
s o c k e t h e a lin g
lie v e
o u r e x p e r ie n c e w o u ld
t h a t le s s t i m e t h a n
have
tw o
w ith le d
us
e x tra c to
900
w o u n d o r le s io n , m e a s u r e d c h r o n o lo g ic a lly , ■ JADA, Vol. 87, October 1973
b e n ig n , a n d c lin ic a lly p e r s is te n t .2
The views expressed herein are those of the authors and do not necessarily reflect the views of the US Air Force or the De partment of Defense. Dr. Tarsitano is a colonel in the US Air Force Dental Corps. His address is USAF Hospital Wiesbaden, Box 305, APO New York, 09220. Dr. Holmes Is a lieutenant colonel in the US Air Force Dental Corps, at the Medical Center, Wright-Patterson AFB, Ohio 45433.
be
y e a r s is r e q u i r e d
t o f i l l in a n i n t r a b o n y d e f e c t . A
fu n c t io n a l, in t e r m it t e n t in g r o w t h , a n a t o m ic a lly
1. Bhaskar, S.N. Synopsis of oral pathology. St. Louis, C. V. Mosby Co., 1961. 2. Robinson, H.B.G. Ameloblastoma: survey of 379 cases from literature. Arch Pathol 23:831 June 1937.