Trends in Pediatric Ameloblastoma and its Management: A 15year Indian Experience.

Abstract

The purpose of this study is to put forth our 15year experience with pediatric ameloblastoma in the Indian population. This retrospective study was carried out in the pediatric group of 18years and below, presenting with and diagnosed for ameloblastoma, at our institution over the past 15years. The required data was collected by reviewing patient's case notes, relevant radiographs, histopathological reports, and treatment charts. The incidence of pediatric ameloblastomas with respect to age, sex, site of occurrence, histopathologic type, the type of treatment instituted, and recurrence rate was noted. Of the total 165 pediatric tumors, ameloblastoma was the most common, 29 cases (17.5%). It occurred commonly in the age group of 12-18years (mean age 14years) with a marked male predilection. The most common site of occurrence was the posterior mandible. Majority were of the unicystic type. Two ameloblastomas which appeared as unilocular radiolucency were diagnosed as solid type. Twenty-eight were benign and one was a rare malignancy (Ameloblastic carcinosarcoma). Only two recurrences were noted over 15years, of which one tumor interestingly recurred as a peripheral variety which responded well to local excision. Ameloblastomas were either enucleated with mechanical curettage or resected followed by primary reconstruction with either a reconstruction plate or free fibula flap. We conclude that ameloblastomas are not uncommon in Indian pediatric population. Unilocular, unicystic ameloblastomas in the pediatric age group can be treated conservatively owing to their growth potential. Emphasis must be given to a long-term regular follow-up, conserving a more radical approach in case of a recurrence. However, Unilocular appearing ameloblastomas may be of the solid type which needs to be borne in mind as it not only alters the treatment modality but also emphasizes the importance of pre-operative incisional biopsy. Solid and unicystic aggressive ameloblastomas must be treated radically. Primary reconstruction with the free fibula flap is a viable option.