Surgical management of ameloblastomas: conservative or radical approach? A critical review of the literature

Abstract

AbstractAim: The aim of this study is to review the pertinent literature and determine the most appropriate method of treatment for ameloblastomas.Methods: A computerized literature search using MEDLINE was conducted for published articles on treatment of ameloblastomas. Mesh phrases used in the search were: ameloblastoma AND treatment; ameloblastoma AND surgical management. An attempt was made to conduct a systematic review on the subject, but due to inconsistency in terminology, treatment protocol, lack of randomised controlled trial and inadequate follow‐up assessment in most of the articles assessed, a narrative critical review of selected relevant literature regarding treatment of ameloblastoma was undertaken.Results: It is widely reported that the recurrence of an ameloblastoma in large part reflects the inadequacy or failure of the primary surgical procedure. Recent studies have unequivocally showed that when a diagnosis of ameloblastoma is made, the treatment must be aggressive and radical to avoid recurrence. The recurrence rates of 55% to 90% for solid or multicystic lesions treated by conservative approach (enucleation or curettage) and even metastases have been reported. Regarding unicystic ameloblastoma, systematic review of the literature has shown that radical approach to treatment resulted in lowest recurrence rate. For ameloblastomas, the first operation (especially radical) affords the best chance for cure.Conclusions: There is a lack of consensus on the most appropriate treatment modality for ameloblastomas. However, a more radical approach (whenever possible) appears to be the best method for the management of these benign, but locally aggressive, lesions with propensity for multiple recurrences.