Diagnosed with Ameloblastoma

I understand the anxiety you are facing. First moments of recovery with my wife in the hospital room I wrote on the dry-erase board “What have I done?”
But recovery was quick.
You are in excellent hands with Dr. Arce and his team. They have taught numerous folks around the world this unique procedure.
Feel free to ask me any questions about this upcoming surgery. When are you scheduled?

I submitted all of my scans, MRI's etc and today, within 3 days of contacting them, I heard back from Mayo with an appointment date for Dr. Arce. I was so excited that I felt like I won the lottery! Since this surgery on my maxilla is inevitable, I'm just pleased to have a physician who has experience in this area. I wonder how much time will be between the consultation and a surgery date... Since Diagnosed in April I've thought about nothing else, and at this point, just want to get it going. Feeling grateful to this forum for everyone's support.

We live about five hours drive away. They sent us home after a week in hospital. My wife made me get out of the car a couple of times to walk around a bit, good for the blood flow they said. Anyway, after two weeks we returned to have the tube removed however, Docs wanted to check a few things, their schedule had an emergency, etc. result was an unexpected overnight without our equipment for tube feeding.
We actually ended up holding off on the tube removal and returned a week later.
I’m smiling likely because all other news was great concerning the healing process. Pain was minimal. And the best laid plans of mice and men……

Even in this photo you are smiling--not long after surgery! And your face looks good. How on earth do you get out the door of the hospital with a feeding tube, and on your way? I didn't hear back from Mayo on line, so I'm going to call in the morning.

Photo attached shows my wonderful feeding tube with a makeshift liquid lunch bag suspension using a hanger and hotel lamp. We weren’t prepared for an overnight in Rochester. Schedules change, emergencies happen. Note the CAM boot on the floor.
I have enjoyed a lot of life in those past five years.

Like many on here, my maxillary + FFF surgeries (6 hours) was performed by the team of Arce/Ettinger. My surgery was on a Tuesday and I flew home on a Saturday, using a walking boot (wheelchair in O"Hare) and cane.

I had a feeding tube for three weeks (removed locally by my PCP) and found it be quite efficient since I am the type that I eat to live and not live to eat. You just have to be VERY careful not to catch the feeding tube on something because it is stitched in place in your nostril. The ouch is very painful and I probably did this once a day.

I was driving within 2-3 weeks (four years ago so my memory is fading) and walking 3 miles again in 5-6 weeks. I used to be a competitive racquetball player and the FFF might have affected that had my back not failed me in 2019.

Like you, I sometimes wonder if I could have found a local solution (my ENT referred me to maxillary surgeon at Baylor-Dallas) but with the help of my PCP, I ended up choosing the Mayo Clinic, specifically because my age, and my ameloblastoma tumor in my right sinus cavity.

I made several follow-up trips to Rochester in 2021-2022 and now make annual trips every summer to see Dr. Arce and Dr. Muller (prosthodontist) and when I fly home -- I am always glad I chose the Mayo Clinic, even if it costs me about $1K per trip.

@tomschwerdt. I felt very soft tissue behind my upper right molar and in my heart knew something was terribly wrong. I asked my dentist about it a year ago. Showed nothing on an X-ray. I asked again a year later when the tissue become very soft. He said a cyst and referred me to an oral surgeon. Meanwhile there was sinus blockage, so an ENT actually felt the soft tissue in my gum at my request and asked that I see a maxillofacial surgeon who would go into the Sinus surgery with him. That Maxillofacial surgeon drained the cyst first to see what he'd be dealing with during sinus surgery, and from that we discovered Ameloblastoma. Now no sinus surgery, as I have this bigger issue to deal with. Since draining the Amelo. the next CT scan showed the sinuses opened some. They expect to take two or three teeth and if so say I need the fibular transplant. I have a good ENT surgeon but he did admit never dealing with an Aemloblastoma in the maxilla (I know rarer than others), but he is a tumor specialist for ENT. I trust this doctor and his vascular partner in surgery, but in my heart want to go to Mayo for another opinion. I have to get to my documents to look up tumor size, and will get back to you. Ive had 3 CT scans, a PET scan, 4 MRIs. Dr said the tumor has likely been there for 10 yrs.

Also: Could you share how your ameloblastoma was found, what symptoms you currently have and what analysis or treatment you've had so far. Do you have a pathology report? X-rays? Was the tumor largely removed during the biopsy? How large is the tumor?

Only share what you're comfortable with.

Okay, I did some digging on the NIH PubMed site. Below are some papers to start with - and especially to share with your doctors. I showed up to MD Anderson with a stack of research papers I had printed out (and a set of links available as well).

You have a rarer type of an already very rare tumor. Maxillary ameloblastomas are thought to be 15-20% of all ameloblastomas.

Good overview/starting point for maxillary ameloblastoma: https://pmc.ncbi.nlm.nih.gov/articles/PMC7652510/

As I mentioned earlier, mandibular ameloblastomas tend to have a BRAF mutation. According to the papers I've found, maxillary ameloblastomas tend to have a SMO mutation, specifically "SMO encoding p.Leu412Phe" per the paper and linked with the Hedgehog signalling pathway. I believe that this mutation is also referred to as "SMO L412F". More rarely, it could be SMO-W535L.

Overview of mutations in ameloblastomas: https://pmc.ncbi.nlm.nih.gov/articles/PMC4418232/

In some other cancers with this mutation, SMO inhibitors have been used as targeted chemotherapy. I haven't dug into how effective they are. The three I've found which are FDA-approved to treat some kind of cancer are Vismodegib, sonidegib, and glasdegib. They're not likely to have specific approval for ameloblastoma, so a doctor using them to treat ameloblastoma would be prescribing "off label" - which is actually pretty common.

My initial understanding is that the SMO mutation triggers overactivity in the Hedgehog pathway and the targeted therapy drugs slow it down.

Targeted therapy for SMO ("Smoothened") mutation cancers: https://pmc.ncbi.nlm.nih.gov/articles/PMC9605185/

Reminder: I'm not a medical professional. I'm just a former research scientist in a very different discipline, doing a basic literature search and reporting what I've found.

These days I oversee more than a dozen research projects which others are leading/heading up. I haven't done hands-on research in years.

Oh yes, any direction you can point me in in terms of the maxillary mutations would be most helpful.