The Hidden Dangers of Decompressing Ameloblastomas: Evaluating Risks, Recurrence, and Treatment Outcomes

Decompression of conventional (previously the multicystic/solid type) ameloblastoma remains controversial. Ameloblastomas are locally aggressive and have high recurrence rates after decompression, a treatment approach that requires critical evaluation.

To compare time to definitive treatment between subjects with conventional ameloblastoma initially managed with decompression and those treated with immediate resection.

Retrospective cohort study conducted at the University of Illinois Chicago from 2007 to 2024. The study sample included subjects with histopathologically confirmed conventional ameloblastoma treated initially with decompression or immediate resection. Exclusion criteria included incomplete records or having had <4 months of follow-up.

Initial therapeutic approach consisted of either decompression or immediate resection.

Time to definitive treatment, defined as the interval from initial treatment to definitive surgical treatment. Secondary outcomes are as follows: decompression duration, number of follow-up visits, decompression failure, subsequent need for resection, and recurrence during available follow-up.

Age, sex, and radiographic appearance (unilocular or multilocular).

Time-to-event outcomes were evaluated using Kaplan-Meier estimates; group differences assessed with log-rank testing. Cox proportional hazards modeling quantified the association between decompression and time to definitive surgery, with subjects lost to follow-up censored. Descriptive statistics were reported as mean (SD) for continuous variables and n (%) for categorical variables. Fisher exact test and t tests were used for between-group comparisons. A two-sided P value < .05 defined statistical significance.

Eighteen subjects (mean age, 24.0 [SD, 16.8] years; 8 [44.4%] male), including 11 (61.1%) initially treated with decompression and 7 (38.9%) with immediate resection. Median time to definitive treatment was 602 days (interquartile range, 308 to 2393) in the decompression group and 76 days (interquartile range, 60 to 800 in the immediate resection group. Decompression was associated with a lower rate of definitive treatment (hazard ratio, 0.05; 95% CI, 0.02 to 0.13, P < .001). Decompression failure occurred in 10 of 11 subjects (90.9%).

Initial decompression of conventional ameloblastoma was associated with a longer time to definitive treatment than immediate resection. Early resection should be considered to avoid a prolonged treatment course and complications, and longer and more uniform follow-up is needed to compare disease-free outcomes.