Analysis of Surgical Approaches for the Treatment of Ameloblastoma: An Integrative Review

Abstract

Ameloblastoma is a slow-growing and aggressive, often asymptomatic, benign odontogenic tumor capable of infiltrating peripheral tissues. It represents approximately 11% of odontogenic tumors. Its origin is still unknown, although it is believed to derive from epithelial cells remaining from the dental lamina and buccal mucosa. It is predominantly located in the mandible, occurring in about 85% of cases, mainly in the posterior region of the mandibular body. Radiographically, it is identified as a uni- or multilocular radiolucent lesion, with well-defined margins and opaque borders. The multicystic type is more common, exhibiting a more aggressive and expansive behavior, often associated with a higher rate of recurrence. On the other hand, single-tissue tends to present less tissue infiltration and aggressiveness. The primary treatment is surgical and can be performed radically or conservatively, depending on the stage and aggressiveness of the tumor. Objective: The objective of this study is to establish a relationship between the technique selected for the treatment of ameloblastoma, the histological type of the tumor, and the recurrence rate documented in the literature. Methodology: This is a literature review carried out using articles from the BVS, SciElo, and PubMed databases. For the literature review, the descriptors were combined by Boolean operators. From this, 13 original articles published between 2009 and 2023, in English, Portuguese, and Spanish, and available in full, were selected. As exclusion criteria, theses, monographs, and experience reports were excluded. Discussion: In the treatment of ameloblastoma, the selection of the surgical approach is influenced by the histological type of the lesion. For cases requiring conservative treatments, enucleation associated with curettage represents a viable option, especially in small to moderate unicystic ameloblastomas. On the other hand, for situations that require more aggressive approaches, en bloc resection is preferable, and is indicated for multicystic or unicystic ameloblastomas of large extension. Although it is not an inflexible norm, statistically, more radical surgical approaches tend to have lower rates of recurrence in all cases, while conservative treatments applied to multicystic ameloblastomas demonstrate significantly higher rates of recurrence. Therefore, there is a direct correlation between the histological type of ameloblastoma, the choice of treatment, and, consequently, the risk of recurrence. Conclusion: The selection between conservative and radical surgical approaches in the treatment of ameloblastoma is determined by the histological profile of the lesion. Enucleation and curettage are recommended for smaller single-cystic lesions, while en-bloc resection is preferred for larger multicystic lesions, associated with a lower recurrence rate.