Is there a role for enucleation in the management of ameloblastoma?

Pogrel, M. Anthony; Montes, David M.

doi:10.1016/j.ijom.2009.02.018

Cited by 155 publications

(156 citation statements)

References 57 publications

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“…We found the unicystic variety to be the most common type (69 %) which is a common finding in some studies [6,17,18]. However, another study has found the solid variant to be the predominant one [15].…”

Section: Discussionmentioning

confidence: 57%

Trends in Pediatric Ameloblastoma and its Management: A 15 year Indian Experience

Andrade¹,

Shetye²,

Mhatre³

2012

J. Maxillofac. Oral Surg.

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Purpose The purpose of this study is to put forth our 15 year experience with pediatric ameloblastoma in the Indian population. Materials and Method This retrospective study was carried out in the pediatric group of 18 years and below, presenting with and diagnosed for ameloblastoma, at our institution over the past 15 years. The required data was collected by reviewing patient's case notes, relevant radiographs, histopathological reports, and treatment charts. The incidence of pediatric ameloblastomas with respect to age, sex, site of occurrence, histopathologic type, the type of treatment instituted, and recurrence rate was noted. Results Of the total 165 pediatric tumors, ameloblastoma was the most common, 29 cases (17.5%). It occurred commonly in the age group of 12-18 years (mean age 14 years) with a marked male predilection. The most common site of occurrence was the posterior mandible. Majority were of the unicystic type. Two ameloblastomas which appeared as unilocular radiolucency were diagnosed as solid type. Twenty-eight were benign and one was a rare malignancy (Ameloblastic carcinosarcoma). Only two recurrences were noted over 15 years, of which one tumor interestingly recurred as a peripheral variety which responded well to local excision. Ameloblastomas were either enucleated with mechanical curettage or resected followed by primary reconstruction with either a reconstruction plate or free fibula flap. Conclusion We conclude that ameloblastomas are not uncommon in Indian pediatric population. Unilocular, unicystic ameloblastomas in the pediatric age group can be treated conservatively owing to their growth potential. Emphasis must be given to a long-term regular follow-up, conserving a more radical approach in case of a recurrence. However, Unilocular appearing ameloblastomas may be of the solid type which needs to be borne in mind as it not only alters the treatment modality but also emphasizes the importance of pre-operative incisional biopsy. Solid and unicystic aggressive ameloblastomas must be treated radically. Primary reconstruction with the free fibula flap is a viable option.

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Section: Discussionmentioning

confidence: 57%

Trends in Pediatric Ameloblastoma and its Management: A 15 year Indian Experience

Andrade¹,

Shetye²,

Mhatre³

2012

J. Maxillofac. Oral Surg.

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“…Multiple studies have consistently indicated that the initial surgical approach most strongly correlates with tumor recurrence [1,[9][10][11][12][13]. While curettage and enucleation with or without adjuvant Carnoy's solution and marsupialization may be acceptable therapies for some unicystic ameloblastomas, most experts currently believe that these treatment modalities have no role in management of solid/multicystic ameloblastoma [4,10].…”

Section: Discussionmentioning

confidence: 99%

“…Histopathologic study of 82 ameloblastoma resections showed that the tumor extends with a range of 2-8 mm beyond its radiographic margins [16]. Thus, many experts endorse that solid/multicystic ameloblastomas should be excised with at least 1-2 cm margin, which typically results in a segmental resection, maxillectomy or mandibulectomy [4,[9][10][11]. In a recent study of 305 patients with ameloblastoma and longterm follow-up, Hong et al [9] found that patients managed by marginal resection demonstrated significantly higher recurrence rate when compared to those who underwent segmental resection or maxillectomy (11.6 vs. 4.5 %, p = 0.004).…”

Section: Discussionmentioning

confidence: 99%

“…Recent data from several centers suggests that the initial surgical management approach and histologic growth pattern are the most important prognostic determinants in ameloblastoma [2,[9][10][11]. Radical surgery can achieve recurrence rates as low as 0-4.5 % and wider resection may be required for ameloblastomas with more aggressive histologic patterns, such as follicular, granular cell, and acanthomatous variants [9,11,12].…”

Section: Introductionmentioning

confidence: 99%

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Ameloblastoma: 25 Year Experience at a Single Institution

Milman

Ying

Pan

et al. 2016

Head and Neck Pathol

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Ameloblastoma is a rare, locally aggressive odontogenic neoplasm, accounting for fewer than 1 % of head and neck tumors. Recent literature suggests that the initial surgical approach and histologic growth patterns are the most important prognostic determinants in ameloblastoma. The aim of this study was to compare the clinical presentation, management, and outcomes of patients with ameloblastoma with data reported in the literature; the study spanned 2 decades at a single institution. The institution's database was searched for all patients with pathologically confirmed ameloblastoma, diagnosed between 1990 and 2015. The data collected included sex, age, clinical and imaging findings, management, histologic pattern, clearance of surgical margins, length of follow-up, time to recurrence, and disease-related mortality. The potential risk factors of recurrence were evaluated using log-rank test, proportional hazard model, and Fisher exact test. Review of the database yielded 54 patients with pathologically confirmed ameloblastoma and follow-up. Recurrence was noted in 13 (24 %) patients. Surgical approach was associated with the risk of recurrence (6.1 % following radical resection vs. 52 % following limited surgery, p = 0.002). There were trends toward higher recurrence rate in the group with pathologically documented positive margins (p = 0.054) and in follicular ameloblastoma (p = 0.35). Transformation into ameloblastic carcinoma was identified in two patients. There was no disease-related mortality. Our study confirms the recent data regarding the importance of radical surgical resection in management of ameloblastoma. Surgical approach appears to be the strongest predictor of tumor clearance.

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“…The recurrence is higher in the solid or multicyst forms, especially in case of simple enucleation or curettage. Bone resection is the best treatment by taking a large margin [14,15] (Figs. 7 and 8).…”

Section: Discussionmentioning

confidence: 99%

Neglected ameloblastomas: a case report

Rakotoarison¹,

Willy

Randriamanantena

et al. 2012

Med Buccale Chir Buccale

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-The aim of this article is to present a case of neglected ameloblastoma due to socio-economic status problem. Ameloblastoma is a benign odontogenic tumor though locally aggressive that usually occurs in the mandible. Its insidious development makes the diagnosis more or less late. Negligence plays an important part in the management of this pathology. It leads to a big tumor whose treatment will be more disabling without more expensive reconstructive surgery. Résumé

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Is there a role for enucleation in the management of ameloblastoma?

Cited by 155 publications

References 57 publications

Trends in Pediatric Ameloblastoma and its Management: A 15 year Indian Experience

Trends in Pediatric Ameloblastoma and its Management: A 15 year Indian Experience

Ameloblastoma: 25 Year Experience at a Single Institution

Neglected ameloblastomas: a case report

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