Study Design: Ameloblastoma is a benign odontogenic tumor of epithelial origin, with locally aggressive behavior; and due to its invasiveness has increased recurrence rates. It is more frequent in the mandible than the maxilla. Surgical treatment is performed with approaches ranging from conservative to radical surgery, either followed by microvascular reconstruction, or not. Adjuvant treatment has shown better local control in refractory cases. Multiple relapses are associated with BRAF gene mutation at codon 600. Objective: This case series aimed to describe the clinical, imaging, histopathological, therapeutic and mutational characterization of 3 patients with refractory ameloblastoma in the maxilla. Methods: Data of 3 patients were collected, and descriptions were provided of procedures such as clinical, imaging, surgical technique, histopathological subtype and molecular analysis for detection of BRAFV600E mutation. Results It was obtained a locoregional control after RT of two cases described. After BRAF mutation molecular analysis, no patient presented it. Conclusion: Surgery remains the gold standard for the treatment of ameloblastomas, even in refractory cases; however, an expanded approach to obtain free surgical margins, and reconstruction of the maxilla itself may be challenging. Adjuvant radiotherapy is still a controversial topic, but could favor reduction of the local recurrence rate in cases where the surgical margins are compromised after surgical resection. Further studies will be necessaries for analysis of the BRAFV600E mutation, for therapeutic purposes.
Background and Objectives: Parotid cancer (PC), when treated surgically, may have associated damage to the functionality of the facial nerve. The role of radiotherapy in the recovery of facial motricity remains controversial. This study aimed to evaluate the impact of radiotherapy (RT) on facial nerve functionality in patients who underwent parotidectomy and facial nerve microsurgical reconstruction. Materials and Methods: Four groups of patients were composed: (a) those who underwent parotidectomy without facial nerve reconstruction and RT; (b) those with nerve reconstruction and without RT; (c) those without nerve reconstruction and RT; and (d) those with nerve reconstruction and RT. Results: 49 patients were male, and 43 were female. A total of 89 underwent parotidectomy, 45 partials, and 44 total. Thus, in nine patients, the sural nerve was used for microsurgical reconstruction. Moreover, 48 patients had a normal facial pattern, 15 with paresthesia, and 29 with permanent paralyses after the House–Brackmann (HB) scale evaluation. Conclusions: The evaluation of nerve functionality after parotidectomy by the House–Brackmann scale is a feasible way to evaluate facial motricity that has already decreased in these patients. Finally, longitudinal studies must be performed to clarify the role of each therapy in the multimodal approach and their clinical impact in facial nerve function.
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