Argument for the conservative management of mandibular ameloblastomas

Abstract

Ameloblastoma is a rare, benign, odontogenic tumour that affects the mandible more commonly than the maxilla. Solid or multicytic variants are often resected and the defects reconstructed with a free flap. To establish the outcome after enucleation and application of Carnoy's solution, irrespective of histological subtype, we used the hospital's histology database to identify all the patients treated between 2001 and 2014 by one surgeon. Variables included patients’ characteristics, histological subtype, radiological appearance, follow-up period, and incidence of recurrence. A total of 27 patients (13 male) were included, mean age 41 years (range 12-79). Fifteen (56%) had solid multicystic lesions, and there was an overall predominance of the follicular or plexiform variant, or both. Of the 23 preoperative radiographs that were available, 17 lesions were unicystic, 5 multilobular and scalloped with no septa, and one had aggressive features of multilocularity and a poorly defined peripheral margin. The mean duration of follow up was 38 months (range 3-156). Three patients had recurrence at 20, 27, and 35 months postoperatively, and each had repeat enucleation and application of Carnoy's solution. Reconstruction was not necessary, and to date none has recurred. This study shows the potential benefits of conservative surgery and sterilisation of the cystic cavity with Carnoy's solution. Recurrence is low, and with vigilant surveillance, similar repeat procedures have been effective when necessary. A longer follow-up period and larger numbers of patients are now needed to corroborate these findings.