An Evaluation Of Conservative Surgical Treatment For Mandibular Ameloblastoma: Report Of Cases And Review Of The Literature

ObjectiveSurgical treatments for ameloblastoma have been categorized into conservative and radical surgeries. Conservative surgeries generally refer to those modalities that do not apply en bloc resection for the removal of ameloblastoma, such as enucleation, curettage and peripheral ostectomy. There have been many controversies regarding conservative surgery for the treatment of multicystic ameloblastoma, owing to its high rate of recurrence. In this article, one case of mandibular multicystic ameloblastoma and one case of mandibular unicystic ameloblastomas were described. Both cases were treated by combined curettage and peripheral ostectomy. A discussion of indications, treatment outcomes, benefits and pitfalls of conservative surgery is presented along with a review of the literature.Material and Method(1) Case 1: 36 y/o female, right mandibular angle, multicystic ameloblastomaThis 36 y/o female was referred from other hospital in Feb. 1995 with a chief complaint of right cheek swelling and unhealed draining extraction socket over right lower molar area. The clinical diagnosis was mandibular cyst or ameloblastoma. She was initially treated by enulceation because she concerned very much about her appearance after surgery. She discontinued follow-ups for 3 years until Jan. 1999, and returned with recurrent right mandibular multicystic ameloblatoma which was treated by curettage and peripheral ostectomy. Another wound curettage was done in June 1999, with pathology report saying chronic inflammation. (2) Case 2: 14 y/o male, left mandibular angle and ramus, unicystic ameloblastoma This 14 y/o male was referred from other hospital with a pathologic diagnosis of ameloblstoma in Oct. 1999. Considering his age and facial skeletal development, we decided to performed conservative surgery consisting of curettage and peripheral ostectomy for this boy. During surgery, there was only one bony cavity found, and buccal and lingual cortical plates were intact. The inferior alveolar nerve was intact after tumor removal. The postoperative pathology was ameloblastoma.Results(1) Case 1: 36 y/o female, right mandibular angle, multicystic ameloblastoma There were three remaining slow-growing mandibular radiolucent lesions over right mandibular angle and body, judging from panoramic films taken in Jan.2001, Jan. 2004, Jan. 2007 and Jan. 2009. Another surgery was indicated again. She concerned about her appearance after surgery so much that she only accepted conservative surgery, hoping not to cause asymmetry of her lower part of face. She is happy by far with this result, although the tumor remains.(2) Case 2: 14 y/o male, left mandibular angle and ramus, unicystic ameloblastoma After few years of follow up, there were two radiolucent lesions over mandibular left angle area found on panoramic film in Jan. 2003. These radiolucent lesions grew slightly large in Jan. 2009. Another surgery may be necessary later. This male patient has grown up with a normal symmetric facial appearance.ConclusionIn addition to the complete removal of lesion, the primary goal of conservative surgery is the prevention of postoperative morbidities pertaining to facial growth, esthetics, and dental occlusion. However, the high risk of recurrence should not be ignored. Accurate preoperative diagnosis, proper design and timing of surgical procedures are mandatory. Efforts should be made to render possible recurrences operable.