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The Ameloblastoma: Primary, Curative Surgical Management

2006; Elsevier BV; Volume: 64; Issue: 3 Linguagem: Inglês

10.1016/j.joms.2005.11.032

1531-5053

Eric R. Carlson, Robert E. Marx,

Soft tissue tumor case studies

The epithelial odontogenic tumor, ameloblastoma, is a neoplasm of the jaws whose surgical management represents a prototype for the treatment of jaw tumors in general. This notwithstanding, numerous methods of treating this tumor have been proposed in the literature that have served as a source of information and disinformation for surgeons internationally. Earlier reports fail to consider the classification of the ameloblastoma in case series recommending a variety of surgical modes of therapy, while more recent recommendations fail to agree on the biologic behavior of the neoplasm. 1 Gold L. Biologic behavior of ameloblastoma. Oral Maxillofac Surg Clin North Am. 1991; 3: 21 Google Scholar The end result has been polarization of the specialty regarding 2 diametrically opposed categories of treatment, incorrectly termed "conservative" and "radical." It is our opinion that each of these terms is inaccurate. We believe conservative therapy to be an oxymoron, as it has never been proved that conservative surgery is therapy with any chance of cure. In addition, radical is too strong a word to describe a curative resection for this aggressive neoplasm. While our specialty is divided on the issue of which type of surgery is better, it is our experience that patients may be cured when a scientific approach is followed with regard to the linear and anatomic barrier margins associated with a segmental or marginal resection of this tumor, whose soft and hard tissue margins in the specimen are determined to be histopathologically negative. The literature has referred to this method of treatment as "radical." 2 Mehlisch D.R. Dahlin D.C. Masson J.K. Ameloblastoma A clinicopathologic report. J Oral Surg. 1972; 30: 9 PubMed Google Scholar The management of the ameloblastoma by more conservative measures such as enucleation, enucleation and curettage, surgical excision and peripheral ostectomy, and enucleation with liquid nitrogen cryotherapy has a more unpredictable course with a far lower rate of cure. Cure should clearly be the primary objective of all tumor surgeries of the oral and maxillofacial region, and should be the goal from the outset. To this end, studies document the failure of conservative surgeries for the ameloblastoma and also point to the lack of uniform success of radical surgeries in salvaging these failures. 3 Sehdev M.K. Huvos A.G. Strong E.W. et al. Ameloblastoma of maxilla and mandible. Cancer. 1974; 33: 324 Crossref PubMed Scopus (202) Google Scholar These observations form the basis of this controversy in the literature. Letter to the Editor 2006Journal of Oral and Maxillofacial SurgeryVol. 64Issue 8PreviewThank you for publishing the clinical controversy last month (J Oral Maxillofac Surg 64:476-483) in which I expressed my views regarding conservative therapy of ameloblastoma and the excellent response by Drs Eric R. Carlson and Robert E. Marx. Indeed, in several of the cases they presented, I would agree with their treatment plan. Of note is the comment toward the end of their article in which they equate a similar controversy with the management of desmoid (aggressive fibromatosis) stating that these share similar controversy with regard to surgical therapy including adequate margins, and so on. Full-Text PDF