Mandibular ameloblastoma: clinical experience and literature review.

BACKGROUND: Ameloblastoma is a locally aggressive odontogenic tumour of the mandible and maxilla that, if neglected, can cause severe facial disfigurement and functional impairment. A thorough understanding of its clinicopathological behaviour is essential to avoid recurrence associated with inadequately treated disease. Currently, wide resection and immediate reconstruction is the treatment of choice in most cases of mandibular ameloblastoma. We present our experience in the management of this disease and review the current status of the literature.
METHOD: Retrospective review of all patients between 1996 and 2006 with histologically confirmed ameloblastoma. A literature review on the current understanding of this disease and its management is then presented.
RESULTS: Six patients were identified, ranging between 23 and 54 years old. All were females. Two tumours involved the angle and posterior body of the mandible, one the angle and ramus, one the body and two the anterior mandibular. Four patients underwent mandibular reconstruction with free tissue transfer and two by non-vascularized bone grafts. All procedures were successful. One patient developed deep vein thrombosis requiring anticoagulation. Another developed a collection at the mandibular surgical site requiring drainage. Satisfactory union was achieved in all cases with no evidence of recurrence. All patients had adequate cosmesis, masticatory efforts and speech.
CONCLUSION: Management of ameloblastoma remains a challenge and requires a thorough understanding of the behaviour of its different clinicopathological variants. We have found segmental mandibulectomy and immediate reconstruction to be an excellent treatment option in our series of patients.