Conservative management (marsupialization) of unicystic ameloblastoma: literature review and a case report

Abstract

BackgroundIn this study, we present a case of unicystic ameloblastoma (UA) treated by marsupialization followed by surgical enucleation as a conservative approach. UA is a rare, benign, less aggressive, and less invasive variant of ameloblastoma that is observed quite often in younger patients. Radical approaches have effects on the physical and psychological development of a growing young patient; therefore, conservative approaches are widely used for UA management in children.Case presentationThis report described a case of an 11-year-old girl with UA of the mandibular molar–ramus area, which also involved impaction of the second and third molars. The lesion was marsupialized, and 31 months after marsupialization, surgical enucleation was performed with extraction of the impacted third molar. The second molar, which was preserved, spontaneously and completely erupted. No recurrence was observed during a 49-month follow-up.ConclusionsConservative treatments for UA in young patients have more advantages. Our results provide evidence that marsupialization is effective in regressing the lesion size to ease complete removal, preserving mandibular growth, maintaining involved second molar, and promoting the eruption of the tooth.

Radical vs conservative treatment of intraosseous ameloblastoma: Systematic review and meta‐analysis

“…This may indicate that the solid or multicystic type behaves more aggressive than the unicystic type. These results are in line with several other reviews (Bisinelli et al, ; Kim, Nam, & Yoon, ; Seintou, Martinelli‐Klay, & Lombardi, ). Therefore, the treatment of ameloblastoma especially for solid or multicystic type should consist of segmental resection with adequate margins.…”

“…These results are in line with several other reviews (Bisinelli et al, 2010; Kim, Nam, & Yoon, 2017;Seintou, Martinelli-Klay, & Lombardi, 2014).…”

Extenso ameloblastoma unicístico em mandíbula: relato de caso

“…Apesar de histologicamente benignos, os ameloblastomas são clinicamente agressivos por apresentarem potencial de destruição dos tecidos locais e grande expansão óssea 4,5 . Frequentemente, essas lesões são diagnosticadas em período inicial, em fase de crescimento lento, quando não provocam sinais e sintomas ou apenas ocasionam aumento de volume 6 . Entretanto, o crescimento tardio do tumor é acelerado e pode ocasionar desordens neurossensoriais, dor, assimetria facial, dificuldades de mastigação e fonação, desordens oclusivas e perdas dentárias 7 .…”

“…Radiograficamente, os AUs apresentam-se como lesões císticas, uniloculares, geralmente em região posterior ou anterior de mandíbula 6,9 . Apesar de sua terminologia, o aspecto multilocular pode estar presente em AU, sendo esta característica mais comum para os ACs 10 .…”

“…Apesar de sua terminologia, o aspecto multilocular pode estar presente em AU, sendo esta característica mais comum para os ACs 10 . Ainda, é possível que a lesão esteja associada a um dente incluso e provoque reabsorções radiculares em unidades adjacentes 6,11 . Exames axiais ou tridimensionais, como a tomografia computadorizada (TC), permitem ainda perceber uma expansão e/ ou perfuração das corticais ósseas, mesmo em lesões iniciais 4 .…”