Management of Ameloblastoma in North Yorkshire- The York Hospital experience over 22 years

Abstract

Introduction: Ameloblastomas are invasive jaw tumours with a recurrence rate related to surgical and pathological factors. This study looks at 15 cases diagnosed and treated in York and reviews histopathology, surgery, follow-up and recurrence. Method: Retrospective review of medical records and literature review. Results: The histological subtypes were solid/multicystic (53.3%), extraosseous/peripheral (13.3%), unicystic (13.3%) and not specified (20%). The surgical management included no treatment (6.7%), wide resection with reconstruction (60%), enucleation (20%) and marsupialisation (13.3%). Follow-up ranged from 4 194 months with a mean followup of 47 months. 79% of patients are still under review. There was 1 recurrence at 291 months, which was a unicystic subtype treated with enucleation. There was also 1 unconfirmed recurrence at 171 months. Discussion: The literature suggests follow-up for 5-10 years although there was no consensus. However, in our series and in the literature there are late recurrences reported at >10years after treatment. Does radical surgery make long follow-up necessary? Although our results imply that it does not, there is not enough supporting evidence. The commissioners want less hospital follow-up generally, as is the case with review of head and neck cancer patients in keeping with new trends in survivorship. There is need for a national BAOMS audit and database for rare tumours to provide more evidence for practise. Since recurrence is related to surgical management we propose separate follow-up protocols for conservatively treated patients and radically treated patients.