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Surgical Excision With Peripheral Ostectomy: A Definitive, Yet Conservative, Approach to the Surgical Management of Ameloblastoma

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

10.1016/j.joms.2005.12.001

1531-5053

Stephen A. Sachs,

Head and Neck Surgical Oncology

The surgical management of ameloblastoma remains as controversial an issue as any in contemporary oral and maxillofacial surgery. Thirty years of clinical practice have taught me that no single approach is suited for every individual case. On one hand, there is a school of thought that advocates major segmental or en bloc resection for ameloblastoma, based on a requirement of 1 to 1.5 cm of clinically or radiographically normal bone to ensure uninvolved margins. 1 Williams T.P. Management of ameloblastoma A changing perspective. J Oral Maxillofac Surg. 1993; 51: 1064 Abstract Full Text PDF PubMed Scopus (67) Google Scholar The opposite point of view is clearly reflected by the numerous case reports that appear in the literature of ameloblastoma managed by curettage. 2 Bataineh A. Effect of preservation of the inferior and posterior borders on recurrence of ameloblastomas of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 90: 155 Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar , 3 Haidar Z. Gailani M. Ameloblastoma The conservative approach. Ann Dent. 1987; 46: 63 PubMed Google Scholar , 4 Himmelfarb R. Ameloblastoma treated by peripheral ostectomy 10 year follow-up. NY State Dent J. 1972; 38: 282 PubMed Google Scholar , 5 Huffman G.G. Thatcher J.W. Ameloblastoma: The conservative surgical approach to treatment: report of four cases. J Oral Surg. 1974; 32: 850 PubMed Google Scholar , 6 Nakamura N. Higuchi Y. Mitsuyasu T. et al. Comparison of long-term results between different approaches to ameloblastoma. Oral Surg. 2002; 93: 13 Scopus (147) Google Scholar , 7 Lello G.E. Smith I. Ameloblastoma with multiple delayed recurrences A case report. Head Neck Surg. 1987; 9: 295 Crossref PubMed Scopus (6) Google Scholar , 8 Muller H. Slootweg P.J. The ameloblastoma The controversial approach to therapy. J Maxillofac Surg. 1985; 13: 79 Abstract Full Text PDF PubMed Scopus (97) Google Scholar This controversy is particularly relevant today in view of the contemporary oral maxillofacial surgeon's mastery of skills that permit segmental resection from an intraoral, as well as extraoral, approach. Future multicenter collaborative investigations are required to evaluate treatment approaches to ameloblastoma objectively. Correlation between biologic behavior, histologic type, location, radiographic appearance, surgical treatment, and long-term results remains to be studied prospectively. 4 Himmelfarb R. Ameloblastoma treated by peripheral ostectomy 10 year follow-up. NY State Dent J. 1972; 38: 282 PubMed Google Scholar , 5 Huffman G.G. Thatcher J.W. Ameloblastoma: The conservative surgical approach to treatment: report of four cases. J Oral Surg. 1974; 32: 850 PubMed Google Scholar Until therapeutic guidelines are developed objectively, it remains each clinician's responsibility to formulate a surgical treatment plan that is individualized and patient centered, and not based on an arbitrary surgical algorithm. In this article, a conservative, yet definitive, approach to some ameloblastomas will be presented. Treatment planning, as well as the surgical guidelines for utilizing surgical excision and peripheral ostectomy (SEPO), will be outlined and illustrated with case studies.