Effectiveness of the Conservative Surgical Management of the Ameloblastomas: A Cross-Sectional Study.

André Caroli Rocha,Jayro Guimarães Júnior,Marcelo Minharro Ceccheti,Alan Roger Santos-Silva,Felipe Paiva Fonseca,Silvia Vanessa Lourenço

doi:10.3389/froh.2021.737424

André Caroli Rocha, Jayro Guimarães Júnior + Show 4 more

Open Access

https://doi.org/10.3389/froh.2021.737424

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Abstract

Ameloblastoma is a benign, but locally aggressive odontogenic neoplasm, whose appropriate therapeutic management remains highly debatable. The aim of this study was to evaluate the reliability and effectiveness of the two conservative surgical therapeutic protocols (curettage with peripheral ostectomy only and curettage plus cryotherapy) for the management of ameloblastomas. About 53 cases of the ameloblastomas treated in 9 years were retrospectively analyzed regarding their clinical, histopathologic, radiographic, and therapeutic data. The results and the postoperative complications related to both the therapeutic protocols were also statistically investigated. A slight female preponderance was seen (1.12:1.0) with a mean age of 27.1 years. The posterior mandible was the most affected site and dental involvement was frequently found. Multilocular lesions causing the alterations of the bone cortices were the most common radiographic findings. Recurrences were seen in 9.4% of the cases and although the patients submitted to curettage plus cryotherapy have shown an increased incidence of wound dehiscence, infection, and paresthesia, only bone sequestration proved to be significantly more frequent in this group compared to the patients treated by curettage with peripheral ostectomy only. The incidence of the recurrences following the conservative management is low and cryotherapy use as an adjuvant tool must be rationally considered.

Highlights

Ameloblastoma represents the most or the second most common odontogenic tumor depending on the source of the sample analyzed and the criteria used [1,2,3]
Because the unicystic ameloblastomas are believed to behave less aggressively, a more conservative surgical approach is frequently chosen for these patients; due to the higher levels of the local recurrences associated with this therapeutic modality, segmental resections with the safety margins associated or not with the adjuvant approaches still represent the most common treatment for all the types of the ameloblastomas [6,7,8]
About 73 patients were initially enrolled in the study; 10 patients did not comply with the minimum 2 years time of follow-up, one patient did not undergo treatment, one patient died due to an unrelated cause, one patient had the diagnosis changed after re-evaluation of the histologic sections, and seven patients were treated by another surgeon, being such cases excluded from the studied sample; remaining 53 cases of the patients had to be analyzed

Summary

Introduction

Ameloblastoma represents the most or the second most common odontogenic tumor depending on the source of the sample analyzed and the criteria used [1,2,3] This well-known benign neoplasia is clinically characterized by a local invasive and destructive potential odontogenic tumor, with a higher level of recurrences, if compared to the other odontogenic tumors. Because the unicystic ameloblastomas are believed to behave less aggressively, a more conservative surgical approach is frequently chosen for these patients; due to the higher levels of the local recurrences associated with this therapeutic modality, segmental resections with the safety margins associated or not with the adjuvant approaches still represent the most common treatment for all the types of the ameloblastomas [6,7,8]

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