J Korean Assoc Oral Maxillofac Surg.  2018 Oct;44(5):242-247. 10.5125/jkaoms.2018.44.5.242.

Conservative surgical treatment for ameloblastoma: a report of three cases

• Kim SW
• Jee YJ
• Lee DW
• Kim HK

• KMID: 2430586
• DOI: http://doi.org/10.5125/jkaoms.2018.44.5.242

Abstract

Ameloblastoma treatment varies based on the clinical, histopathologic, and radiographic characteristics. Aggressive surgical treatments, such as marginal or segmental resection, have traditionally been implemented, but some conservative surgical methods are also being introduced, including decompression, enucleation, or curettage. The aim of the present study was to evaluate the possibility of applying these conservative surgical treatments to ameloblastoma and to analyze the prognosis of the procedures and their healing aspects. Among all patients who visited our clinic (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong) from 2009 to 2017, three who had undergone conservative surgery were recruited. One of these three patients underwent both excision of the lesion and an iliac bone graft during the same procedure. In the other two patients, due to the size of the lesion, decompression was performed to reduce the size of the lesion, and then conservative surgical treatments followed. As shown in the cases of this study, patients were only treated with conservative surgical methods, such as decompression or enucleation. During the follow-up period, there were no recurrences. In conclusion, the use of conservative surgical treatment in ameloblastoma can be a reliable, safe, and successful method.

Keyword

Ameloblastoma; Enucleation; Decompression; Conservative treatment

MeSH Terms

Ameloblastoma*
Curettage
Decompression
Follow-Up Studies
Humans
Methods
Prognosis
Recurrence
Surgery, Oral
Transplants

Figure

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  Fig. 1 A. X-ray shows a fairly large, well-defined rounded cystic destructive lesion involving the left mandibular body. Absorption of the roots of #36 and #37 is also apparent. B. Nine months after surgery, a panoramic view reveals favorable healing of the grafted iliac bone without any inflammation. C. One year five months after surgery, an implant fixture was placed near the #37 area. A 5.0 mm×10.0 mm implant was used, and the insertion path was satisfactory.

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  Fig. 2 Microscopic characteristics. A. Underlying the fibrous capsule, proliferation of neoplastic cells was noted; the cells were arranged in strands and in islands (H&E staining, ×20). B. Mural unicystic ameloblastoma shows invasive islands of the ameloblastic epithelium (H&E staining, ×100).

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  Fig. 3 A. The panoramic view shows a large, round-shaped radiolucent lesion near the posterior teeth. B. Nine months later after decompression, the size of the lesion had decreased. C. One year after surgery, bone formation at the operative site was satisfactory.

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  Fig. 4 Microscopic characteristics. A. The tumor is composed of a partly cystic portion and a solid portion (H&E staining, ×20). B. The tumor contains anastomosing cords and strands. At the center of these anastomoses, the cells are loosely arranged and have a cystic appearance. Each cell is spindle-shaped and has hyperchromatic nuclei (H&E staining, ×100).

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  Fig. 5 A. The panoramic radiograph shows a fairly large, well-defined rounded destructive lesion involving the left mandibular body. B. One year after decompression, the panoramic x-ray reveals that the size of the lesion has decreased. C. Three months after surgery, bone formation has progressed well.

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  Fig. 6 Microscopic characteristics. A. The tumor is composed of a partly cystic portion and a solid portion (H&E staining, ×20). B. The tumor demonstrates a follicular pattern, which is composed of islands of odontogenic epithelium. The basal cells of these islands are column, hyperchromatic, and palisading. Their centers show squamous differentiation (H&E staining, ×100).

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