A treatment algorithm for managing giant mandibular ameloblastoma

Ameloblastoma is a benign odontogenic tumour of the jaws with a locally aggressive behaviour and a
high recurrent rate. In general, ameloblastoma can be categorised into 3 types: conventional solid multicystic,
unicystic and peripheral ameloblastoma.

Conventional ameloblastoma is a slow growing, but locally invasive,
tumour. Some ameloblastomas become gigantic and destroy adjacent tissues. Conversely, unicystic
ameloblastoma frequently occurs in younger populations, and possesses a less aggressive nature and a lower
recurrent rate. It can be either a tumour de novo or a tumour arising from an odontogenic cyst.

Both solid and
unicystic ameloblastoma commonly occur in the mandible, especially the molar-ramus area.1-6

Various therapies for ameloblastoma have been reported. However, the universally accepted approach
remains unsettled. It can range from conservative treatments, such as enucleation with or without curettage, to
aggressive treatments which include peripheral ostectomy and resection.1,2,7 Once mandibular ameloblastoma
becomes gigantic, it requires a radical approach.2,3 Free flap reconstruction is necessary when the resected
defect is larger than 5 cm. Some authors reported the treatment of extensive ameloblastoma using radical
excision with immediate microvascular reconstruction.4-6

Until now, there has been neither definition of nor definite treatment consensus on giant mandibular
ameloblastoma (GMA). In this paper, GMA is defined as mandibular ameloblastoma which consists of three
components: 1) large size (> 5 cm in length), 2) thinning of the inferior and/or posterior mandibular borders,
and 3) considerable jaw expansion. The aim of this study was to review our experiences with this tumour over a
5-year period, and to institute an algorithm for managing GMA.

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