ACANTHOMATOUS AMELOBLASTOMA IN DOGS-Number #50

Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
Advanced Veterinary Dentistry
www.SilverSandsVeterinary.com
AnimalDentistrySolutions.blogspot.com
1-800-838-3368
E-Mail DonDeForge100@gmail.com
Number #50

Canine Acanthomatous Ameloblastoma

Canine Acantomatous Ameloblastom [CAA]
Notes from an Oral Surgeon
Segmental Rim Resection Mandiulectomy [SRRM]

The Acanthomatous Ameloblastoma is a benign yet very aggressive tumor arising from rests of odontogenic epithelium in the submucosa and periodontal ligament of the oral cavity. 

These tumors are locally invasive and destructive, resulting in lysis of alveolar bone and loss of teeth. Because these tumors are so infiltrative, local recurrence is common following excision, and recommended therapy typically includes:
Maxillectomy or Mandibulectomy or Segmental Rim Resection Mandibulectomy [SRRM] . 

If excision can be achieved, the prognosis is good, with 98–100% of dogs having no signs of recurrence 1–2 years after excision.

Radiation therapy has been advocated in cases in which complete excision cannot be achieved because of the size or location of the tumor. Oncology reports have evidenced  with radiation a novel oncogenesis at the irradiated site. Radiation is considered palliative.

Importantly, Acanthomatous Ameloblastoma is not known to metastasize but it is locally very aggressive acting like other malignant oral neoplasms of the dog. 

CT Scan and MRI are available to measure extent of growth. They are not helpful in determining a definitive diagnosis.  That can only be accomplished with histopathology.  

Even if histopathology was performed by the referring LDVM, Dr. DeForge always recommends repeating tissue histopatholgoy with bone and mucosa samples being sent to the laboratory for diagnosis confirmation.

Partial Mandibulectomy and Complete Mandibulectomy have been advocated by oral surgeons.  These surgery procedures are not recommended by Dr. DeForge because they lead to a poor quality of life. Many patients drool excessively; tongues will hang out; or there can be difficulty in lifting of food to eat.

Segmental Rim Resection Mandibulectomy[SRRM] performed by Dr. DeForge~

When excision is incomplete, recurrence is possible with aggressive invasion into bone.
 

Acanthomatous ameloblastoma patients may need multiple surgeries to successfully remove tumor tissue after it has begun to advance.  

In some patients, the tumor cells can extend deep into bone or sublingually.  These patients after multiple surgical corrections have a guarded prognosis.

CT Scan and MRI can be scheduled to view the borders and extent of this very aggressive tumor prior to surgery.  Call Dr. DeForge if you wish a referral to an oncologist for consultation and additional imaging.

Dr. DeForge emphasizes that after SRRM~additional surgery may be necessitated if the mass returns in the surgical site.  

No guarantee of complete surgical removal of the mass, can be provided.  

Prior to SRRM:  With Informed Consent you have many options.  These choices are outlined by Dr. DeForge in detail prior to SRRM to make the decision for care that brings to you............. a special zone of comfort.
  
Dr. DeForge realizes your love for your pet and presents

all options to you prior to surgery.
  
If you have questions, Dr. DeForge is always here to answer them and allow you to have the information you need to make an Informed Decision of Care [IDC]!

Dr. DeForge can refer you for a C-Scan or MRI to evaluate margins if that is your choice prior to surgery [SRRM].

Dr. DeForge can refer you to an Oncologist for a pre-surgical Consultation or a post-surgical consultation for Radiation therapy if the mass recurs after SRRM.

Dr. DeForge can provide a consult with an Orthopedic Surgeon if you wish a Complete Mandibulectomy and refuse SRRM!

If you have already had the mass removed and it recurs, Dr. DeForge recommends re-sending the SRRM tissues to an Animal Histopathologist for confirmation of

the diagnosis made at the time your LDVM performed surgery.

Acanthomatous Ameloblastoma

Final Comments: 

Segmental Rim Resection Mandibulectomy [SRRM]

The Use of Rim Excision [SRRM] as a Treatment for Canine Acanthomatous Ameloblastoma--A review 

Rebecca L. Murray, DVM, Martin L. Aitken, DVM, Diplomate ACVS and Sharon D. Gottfried, VMD, Diplomate ACVS

This study reviews rim excision as a treatment for Canine Acanthomatous Ameloblastomas (CAA) in dogs with <3 mm of bone involvement. Removal of a canine tooth was involved in 47% of the cases; 33% cases involved the caudal dentition. Follow-up ranged from 3 months to 5 years. No evidence of recurrence was seen. Client satisfaction with cosmesis and the animal’s ability to masticate was judged to be good. With appropriate case selection, rim excision [SRRM] appears to be a viable option for CAA and results in improved dental occlusion, cosmesis, and no evidence of recurrence.

Notes from Dr. DeForge: With recurrence after surgery at your general practice additional surgery is advised!  

The earlier the patient is seen the less change of recurrence.  In patients that have had prior surgery or prior surgery with a lapse in time before referral, the chance of additional surgery is higher than in patients seen earlier.

                                Questions: E-Mail DonDeForge100@gmail.com