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A Journal on Dentistry and Maxillofacial Surgery
Minerva Stomatologica 2001 January-February;50(1-2):1-8
Retrospective evaluation on the surgical treatment of jawbones ameloblastic lesions. Experience with 20 clinical cases
D'Agostino A., Fior A., Pacino G. A., Bedogni A., De Santis D., Nocini P. F.
Background. Ameloblastoma is a benign but locally aggressive neoplasm of the odontogenic epithelium that causes expansion of the bone and tends to recur. The aim of this article is to present a retrospective evaluation on the management of ameloblastic lesion of the jawbones and to compare them with those reported in literature in order to rule out which surgical approach is likely to be the most appropriate, considering it extremely controversial.
Methods. Data corresponding to 20 patients with ameloblastic lesions involving the maxillary bones, admitted to the Oral and MaxilloFacial Surgery Department of Verona University Hospital, were analyzed in the period between 1984 and 1999. All data were selected for sex, age, site of involvement, histological patterns of the lesions, surgical steps performed concerning both primary pathology and secondary relapses including the reconstructive methods employed.
Results. The results showed a male/female ratio of 1.5/1. All the affected patients showed endosseous tumour masses localized in 90% of the cases at the mandible and only in 10% at the maxillary bone. Only one case with soft tissue involvement was observed. Treatment was enucleation and bone courettage in the 65% of cases while in 35% the lesion was excised performing wide bone resection. The histopahological study on the surgical specimens revealed the 50% of the lesions were unicystic 45% were multicystic showing the other 5% a carcinomatous ameloblastic patterns. The recurrence rate in patients managed with enucleation and courettage was 28.57% while in wide bone resection none recurrence was observed.
Conclusions. Simply enucleation and curettage of multicystic ameloblastic lesion of jawbones results in an unacceptable recurrence rate. Conservative surgical treatment should be considered only in presence of unicystic lesion when extraosseous spread has not occurred. Multicystic lesions should be treated with an extended surgical resection.