SURGICAL MANAGEMENT OF

AMELOBLASTOMA: REVIEW OF LITERATURE

Journal of clinical and experimental dentistry : 2019

Maj Muhammad Ramzan Adeel

Resident
Oral and Maxillofacial Surgery
 OBJECTIVE

Objective of the present review is to assess whether the surgical

treatment should be conservative or radical
 PRESENTATION LAYOUT

 Critical Appraisal

 Introduction

 Materials and Methods

 Results

 Discussion

 Conclusion
 CRITICAL APPRAISAL
Title Surgical management of ameloblastoma: review of literature
(Journal of clinical and experimental dentistry : 2019)

• Title
Study• Design Observational
Risk factors for and the role of dental extractions in osteoradionecrosis of the jaws
• Study Design
Methodology NIH/NLM was searched for surgical treatment/ surgical management of
• Case series (Cohort study)
ameloblastoma and their results were analyzed
• Methodology
• Data retrieved from National Health Insurance Research Database (Taiwan)
Level •of evidence
Statistics
V
• -
• Results
Conclusion Radical surgery for solid and Multicystic with 10 years follow up. And
• Incidence rate of 3.93 per 100 persons
• Conclusion conservative surgery for Unicystic and Multicystic with small extension.
• Post treatment extraction is associated
Strengths Published
with ORNJ in a major journal
• Strengths
• Carried out on a large data, highlighted the significance of extractions prior to radiotherapy
• Limitations
Limitations Data analysis was carried on small sample
• Several confounders including smoking, betel nuts chewing and tumor staging were not coded in the
Integrated with C level of evidence
• NHIRD

5
 INTRODUCTION

• Ameloblastoma is an odontogenic tumor

• 1% of all oral cavity tumors

• Benign

• 3rd to 4th decade of life

• Equal in both sexes

• 80 % in mandible
 INTRODUCTION

• Unknown pathogenesis

• Origin can be from dental sheets, enamel organ, odontogenic cysts

• Triggers
• Trauma

• Inflammation

• HPV

• Malnutrition and vitamin deficiency

 INTRODUCTION

• Slow growth

• Rare metastasis

• Destruction of cortical bone and soft tissue invasion

• Pain, asymmetry, agglutination, malocclusion

• Resorption of apices

• Paraesthesia
 INTRODUCTION

• DIAGNOSIS
• Incidently on OPG
Non pathogonomic
• Smyptoms

• Confirmed by histopathology

• Mortality due to invasion of vital structures, serious infections, remote

metastasis
 INTRODUCTION

• Clinical Classification
Locally aggressive, high recurrence
• Solid and Multicystic rate

Less aggressive, low recurrence rate

• Unicystic

Responds well to local excision

• Peripheral
 Introduction

• Elective treatment is surgery

• Conservative surgery
• Enucleation

• Marsupialization

• Both and/or combined with chemical/ thermal cauterization

• Radical surgery
• Mandibulectomy

• Segmental resection of lesion

 INTRODUCTION

• Most appropriate surgical option depends

• Recurrence rate

• Mortality and morbidity

• Functional recovery and aesthetic of the patient

• Quality of life after the treatment

 MATERIALS AND METHODS

• Data was collected using U.S. National Institutes of Health’s National - Library of
Medicine (NIH/NLM)

• Keywords

• Surgical treatment ameloblastoma

• Surgical management ameloblastoma

• Radical surgery ameloblastoma

• Conservative surgery ameloblastoma

• English articles published between 2009-2014

RESULTS
 DISCUSSION

• Optimal surgical treatment should

• Minimize recurrences

• Restore function and aesthetic

• Minimal morbidity in the donor area

 DISCUSSION

• Surgical planning
• Patient comorbidities

• The size and location of the tumor

• The techniques available for reconstruction

• Surgeon’s experience
 DISCUSSION

• Conservative technique
• Enucleation, curettage or marsupialization

• Associated with cryotherapy with liquid nitrogen

• Tissue fixers like the carnoy’s solution

• Low morbidity

• Excellent aesthetic and functional results

• high rate of recurrences between 60-80%

 DISCUSSION

• Radical surgery

• Marginal or segmental mandibulectomy with 1-1.5 centimeters margins

• Ameloblastoma cells can be found 8 mm apart from the radiological

and clinical margin of the tumor

• Low recurrence rate, around 0-10%

 DISCUSSION

• Unicystic ameloblastoma is advisable to treat by means enucleation

• Aggressive tumor radical surgery with 0.5-1 cm of margins is advised

with reconstruction

• In the peripheral ameloblastoma the authors recommend local

resection
 DISCUSSION

• Solid and multicystic ameloblastoma radical surgery with margins of 1

cm and resection of adjacent soft tissue with a subsequent

reconstruction

• Recurrence on soft tissue adjacent to ameloblastoma have been

reported after 21 years post-surgery

 CONCLUSION

• According to the present review, radical surgery appears to be the

most recommended option in multicystic / solid and advanced

unicystic tumors, along with long-term follow-up for the possibility of

recurrence beyond 10 years

 CONCLUSION

• Conservative surgery combined with long-term follow-up is reserved

for the unicystic and multicystic / solid types with small extension

• Although despite being less invasive, the recurrence rate is very high