Ameloblastoma surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

The mainstay of therapy for ameloblastoma is surgery. The predominant therapy for ameloblastoma is surgical resection. Adjunctive chemotherapy/radiation/chemoradiation may be required.

Surgery

  • Recurrence rates of ameloblastoma are reportedly as high as 75-90% after conservative treatment and 15-25% after radical treatment.[3]
  • Wide resection of the jaw in accordance with the treatment of malignant tumors is usually recommended for ameloblastomas.
  • Treatment consists of:
  • Treatment decisions for ameloblastoma are based on the following factors:[1]
    • Anatomical location
    • Clinical behavior of the tumor
    • Age
    • General state of health of the patient
    • Size
    • Histologic variant
    • Clinicoradiologic variant
  • Surgery is the most common treatment of this tumor. Excision of normal tissue near the tumor margin is often required, because of the invasive nature of the growth. Ameloblastoma has tendency to spread to adjacent bony and sometimes soft tissues without metastasizing.
  • Although, ameloblastoma is not a cancer that actually invades adjacent tissues, it is suspected to spread to adjacent areas of the mandible via marrow space. Thus, wide surgical margins that are clear of disease are required for a good prognosis. This is very much like surgical treatment of cancer.
  • Often, treatment requires excision of entire portions of the jaw. Surgery is the only effective method for removing the excess tissue growth. A wide surgical excision is often required; in majority of cases, a part of the bone beneath the growth must be removed as well. Surgical curettage of the bone tumor is another treatment modality- although, there is a higher chance of recurrence with this treatment method.
  • Since, surgery is a highly effective method to treat ameloblastoma, in most situations, chemotherapy and radiation treatment is not preferred. Facial reconstructive surgeries may be required, after removal of the tumor. Radiation is ineffective in many cases of ameloblastoma. There have also been reports of sarcoma being induced as the result of using radiation to treat ameloblastoma. Chemotherapy is also often ineffective. However, there is some controversy regarding this and some indication that some ameloblastomas might be more responsive to radiation that previously thought.

References

  1. 1.0 1.1 Gümgüm S, Hoşgören B (2005). "Clinical and radiologic behaviour of ameloblastoma in 4 cases". J Can Dent Assoc. 71 (7): 481–4. PMID 16026635.
  2. Singh M, Shah A, Bhattacharya A, Raman R, Ranganatha N, Prakash P (2014). "Treatment algorithm for ameloblastoma". Case Rep Dent. 2014: 121032. doi:10.1155/2014/121032. PMC 4274852. PMID 25548685.
  3. Infante-Cossio P, Prats-Golczer V, Gonzalez-Perez LM, Belmonte-Caro R, Martinez-DE-Fuentes R, Torres-Carranza E, Gacto-Sanchez P, Gomez-Cia T (August 2013). "Treatment of recurrent mandibular ameloblastoma". Exp Ther Med. 6 (2): 579–583. doi:10.3892/etm.2013.1165. PMC 3786835. PMID 24137230.

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