[Algorithm for the treatment of ameloblastoma in Tunisia]

Ameloblastoma is a benign but locally aggressive and infiltrative odontogenic neoplasm. Numerous methods of treatment have been proposed but the latest studies showed that a radical treatment is the recommended protocol for the surgical management of ameloblastomas. The purpose of this study was to review the clinical features and surgical treatment of ameloblastomas treated in our department and to propose an algorithm for the treatment adapted to our country.

Data was collected from the records of patients treated at our Surgery Unit between 1993 and 2004. Data with respect to the patients' ages, sex, tumor locations, and surgical treatment history, as well as radiographic findings and number of recurrences, was analyzed.

8 male and 5 female patients were included in the study. Sixty-two percent of ameloblastomas were located in the mandibular angle. Swelling was the most common symptom and was experienced by 85% of the patients. A radiographic assessment of the tumors showed that 85% were multicystic. Conservative surgery was used in 92% of the cases. The 8 patients followed-up all presented with recurrence. The other 5 patients were lost to follow-up. A radical treatment was used for 6 of the recurrent ameloblatomas with immediate iliac bone reconstruction. One patient refused radical treatment, he benefited from a conservative treatment, and the other one was lost to follow-up.

This study was characterized by the preponderance of the conservative treatment, the non-specification of histological types, systematic relapse, and the significant number of lost to follow-up. We recommend significant modifications in the management of ameloblatomas in Tunisia, based on radical surgical treatment. This suggests implementing further training of operators (free flaps) and pathologists (histochemistry), as well as a better education and information of patients.