The treatment of ameloblastoma based on pathologic and anatomic principles

A number of important factors must be considered in planning the treatment of ameloblastoma. It is essential to distinguish among the three clinical types of ameloblastoma--the intraosseous solid or multicystic lesion, the well-circumscribed unicystic type, and the rare peripheral (extraosseous) ameloblastoma--because they require different forms of treatment. Unicystic ameloblastomas in which the tumor extends into the lumen of the cyst or involves only the cystic lining can be expected to be removed completely by enucleation. This approach, however, is inadequate if the tumor has invaded the periphery of the fibrous connective tissue wall. Ameloblastomas may invade the intertrabecular spaces of cancellous bone but do not invade compact bone, although they may erode it. Ameloblastomas in the posterior part of the maxilla should be treated more extensively than similar lesions in the mandible because of the proximity of the posterior maxilla to vital structures and the difficulty in treating any recurrences. This article discusses the treatment of ameloblastoma based on these pathologic and anatomic considerations and includes brief discussions of the role of cautery, cryotherapy, and radiotherapy.