Management of mandibular ameloblastoma: the clinical basis for a treatment algorithm.

PURPOSE: This article discusses the management of intraosseous mandibular ameloblastomas as the basis for a treatment algorithm. PATIENTS AND METHODS: The records of 26 consecutive patients referred for management of mandibular ameloblastoma were reviewed. Demographic data, location, number and types of prior surgical treatment, radiographic findings, number of recurrences, and reconstructive methods used were analyzed.
RESULTS: All patients treated with curettage alone developed recurrence (n = 11). No patients treated with either curettage or resection plus liquid nitrogen cryotherapy developed a recurrence (n = 9). Patients whose radiographs showed large tumors with eggshell-thin bony margins, and who underwent segmental resection with excision of the involved soft tissue also had no recurrences (n = 8). In addition, 2 patients were referred with soft tissue recurrence necessitating resection. Both of these patients underwent multiple resective procedures, including neck dissections and skull base resections. All patients were reconstructed with either primary or secondary bone grafting. Only 3 patients went on to have complete dental reconstruction that included osseointegrated implants.
CONCLUSIONS: Curettage of ameloblastoma results in unacceptable recurrence rates. Lesions contained within the mandible are adequately treated by curettage or marginal resection combined with cryotherapy. Segmental resection of the mandible with involved soft tissue, including periosteum, produces acceptable results when extraosseous spread has occurred. The first operation affords the best chance for cure. When tumor recurs in soft tissue, extensive surgery is necessary to salvage the patient. Few patients in this series went on to full reconstruction that included osseointegrated implants.