S323: Surgical Management of Odontogenic Tumors

Abstract

Odontogenic tumors represent a fascinating spectrum of benign and malignant tumors whose management occupies a time-honored place in our specialty’s surgical repertoire. The number of recommended surgical techniques is at least as significant as the number of tumors, leading to much confusion as to the best way to treat these tumors. While it is clear that a majority of these tumors are benign, different types of treatment should be offered to patients with curative intent. Benign odontogenic tumors are highly curable entities such that appropriate, first-line surgical therapy must be planned logically and appropriately. This notwithstanding, there is substantial disagreement in the international literature regarding the biologic behavior of these tumors and how best to treat them. An evidence-based approach to the management of these tumors is therefore required to optimize the chance for cure of our patients, while at the same time minimizing the deformity that might occur. In particular, the solid or multicystic ameloblastoma is a locally aggressive slow-growing benign neoplasm that is prone to persistence when treated in a conservative fashion. As such, it is generally recommended that a resection with 1.0 to 1.5 cm linear bony margins be performed at the onset of disease so as to cure such patients. Such treatment is curative, while also allowing for effective reconstruction to be performed on an immediate or delayed basis. It is our belief that similar surgical treatment should also be performed for the odontogenic myxoma and Pindborg tumor. The unicystic ameloblastoma exhibiting exclusively intraluminal tumor, however, may be treated more conservatively with the same likelihood of cure. An enucleation and curettage surgery is generally regarded as conservative, yet appropriate and curative surgery for this subtype of ameloblastoma. A similar approach may be followed for management of the ameloblastic fibroma and ameloblastic fibro-odontoma. The malignant odontogenic tumors, represented by the ameloblastic carcinoma and the clear cell odontogenic carcinomas, require more aggressive cancer surgeries, and are associated with a less favorable prognosis. Long-term postoperative follow-up is generally recommended for all patients with odontogenic tumors so as to ensure effective tumor control.