Radical Management of Giant Ameloblastomas: A Case Series

Abstract

Ameloblastomas are rare, slowly growing and locally invasive tumours with high recurrence rate, if not treated they can grow to enormous size; we report five such cases in our article and discuss their surgical management. We report five cases of giant ameloblastoma presented in our institute between 2007 and 2010, we treated them surgically with wide margin of resection. It is widely reported that recurrence of ameloblastoma in many cases reflects the inadequacy or failure of the primary surgical procedure. We treated all our cases with radical excision with free flap reconstruction with no recurrence in any of our patients in 2 years follow-up. Radical excision of these benign but locally invasive lesions, which grows to giant size with reconstruction using micro vascular free flaps forms the best modality of treatment.

Individualized treatment for the mandibular segmental defect: a case report

“…Sharma A have reported five cases of such giant ameloblastoma and discussed the surgical management, but restoring the missing teeth and functional reconstruction of the mandible have not been mentioned [5]. In this case, we took the restoration of the missing teeth and the rehabilitation of the masticatory function as well as restoring bony continuities and facial appearance into consideration, communicated well with prosthodontists and implantologists before surgery, making the individualized systematic treatment plan more effective and efficient.…”

Giant multiloculated ameloblastoma of the mandible: a case report and review of literature

“…Many authors have recommended enucleation with preservation of periosteum which is important for bone regeneration especially in children. 7 However, proponents of radical approach are of the considered view that conservative surgical options such as curettage and enucleation result in unacceptably high recurrence rates; the recurrence rate up to 55-90% have been reported in the literature. Curettage is followed by local recurrence in 90% of mandibular and all maxillary ameloblastomas because of insufficient removal of tumors.…”

“…Blood supply to fibula is both intraosseous and segmental, therefore, multiple osteotomies can be made. 7 With such microvascular reconstructive techniques, very good aesthetic and functional results are obtained postoperatively.…”

Améloblastome historique de la mandibule

“…Elle touche principalement les personnes entre 30 et 60 ans, sans prédilection de sexe [1]. Elle représente 11 à 18 % de toutes les tumeurs odontogé-niques et représente la deuxième tumeur odontogène la plus fréquente après les odontomes [1].…”

“…Deux techniques chirurgicales s'opposent. Le traitement conservateur consiste en une énucléation-curetage de la tumeur avec maintien du périoste pour la régénération osseuse, en particulier chez l'enfant [1,5]. Il semble indiqué en cas de petite tumeur unikystique, bien limitée, avec des tables osseuses non rompues [1,5].…”