SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS The failure of anatomically limited, directly invasive, excisional techniques for the eradication of ameloblastoma has been documented repeatedly in the world's literature for at least 60 years. With the exception of certain unilocular lesions, surgical management in this fashion leads to a need for subsequent operations in at least half of all reported cases so treated.10,37,55 Because of the need for repeated procedures, often of increasing complexity and compromise to the patient's function and appearance, and because of the patient's anxieties evoked by an uncertain prognosis, it is hardly fair to term such surgery “conservative.” To this point, although better understanding and refinement of their applications seems to be developing, neither radiation therapy nor chemotherapy can be considered primary modalities in the treatment of ameloblastoma; their current role remains adjunctive or palliative in the management of residual disease beyond the limits of surgical salvage. Because of their rarity, the reported potentials for metastasis or true malignant degeneration of ameloblastoma cannot be used as realistic foundations to support aggressive, ablative, initial care; rather, the overriding arguments for this approach are its consistently higher rate of success and lessened likelihood of subsequent operations and its toleration by an overwhelming percentage of patients. In these contexts, it would seem unfair to deem such care “radical.” In the clinical sense, the ameloblastoma can be considered a basal-cell carcinoma, to which, in fact, it may well be related histologically. The experienced surgeon will not be intimidated by the prospects this parallel implies, and it falls to him or her to ensure that surgeons of lesser expertise appreciate this parallel in their approaches to this most devastating of odontogenic lesions. Experience suggests several principles in the management of ameloblastoma: 1. Aggressive ablative management, in which the lesion is neither violated nor directly manipulated, is the current treatment of choice and must remain so until consistent long-term evaluation or new knowledge to the contrary is brought to bear. Marginal mandibular resection and other procedures short of discontinuity can fall within this perimeter. 2. Extension of ameloblastoma into the surrounding soft tissues is an ominous sign and demands surgery in those sectors as vigorous as that within the confines of the bone. 3. Current retrospective evaluations of ameloblastoma reappearance rates are essentially meaningless; evaluations must encompass significant numbers of patients for a minimum of 5, and preferably 10, years and, ideally, should be prospective in design. 4. Currently, appropriate periodic evaluation of the patient must include CT and, in certain cases, magnetic resonance imaging. 5. Immediate reconstruction is a legitimate undertaking in the patient operated on in aggressive fashion for elimination of ameloblastoma.