ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title The Effect of Radical or Conservative Treatment Option on the Recurrence Rate of Ameloblastoma Depends on Histopathological and Other Clinical Features
Clinical Question For patients diagnosed with ameloblastoma, would the conservative treatment approach of enucleation and curettage result in a lower rate of recurrence as compared to a radical treatment approach of surgical resection?
Clinical Bottom Line For patients diagnosed with ameloblastoma, there are no randomized controlled trials present to clearly establish that radical resection treatment achieves a lower rate of recurrence as compared to the conservative treatment approach. The result for this outcome was supported by retrospective studies comparing the two treatment approaches of ameloblastoma. Although there were higher rates of recurrence reported for the conservative intervention, the judgment on which treatment should be adopted depends on the histopathologic features of the lesion, its morphology, and the patient’s medical history.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16781332Ghandhi/200650 patients with primary ameloblastomaRetrospective study
Key resultsInvestigation centers in Glasgow, Scotland and San Francisco, CA reported that no significant differences were found between conservative treatment of enucleation and/or curettage and radical resective treatment of ameloblastoma. Although there were higher incidences of recurrence reported after conservative treatment (80% of cases), there was not a statistically significant number of patients available in this study to make a clinical and statistical claim about whether one type of treatment is superior to the other.
#2) 27793625Laborde/2017 27 patients with primary ameloblastomaRetrospective study
Key results22 cases of ameloblastoma were treated conservatively (marsupialization, enucleation, and/or curettage), and 14 cases were treated with radical resective surgery. Recurrence rate for conservative treatment was significantly higher (90.9%) as compared to the radical treatment approach (9.1 %) (P = 0.025). Although conservative treatment approach does show a higher rate of recurrence of ameloblastoma, the selection for the type of treatment given depends on the clinical presentation (size/ type of lesion, patient medical history, and histopathologic features) of the lesion.
#3) 22442605Dandriyal/201120 patients with primary ameloblastomaRetrospective study
Key resultsTen patients with primary ameloblastoma were treated with the conservative approach of enucleation and curettage and another 10 cases with surgical resection. Of the 10 cases which received the conservative treatment, 6 showed (60%) recurrence, whereas 1 (10%) showed recurrence in the surgical resection group.
Evidence Search ("ameloblastoma"[MeSH Terms] OR "ameloblastoma"[All Fields] OR "management"[All Fields]) AND (" ameloblastoma"[MeSH Terms] OR "enucleation"[All Fields]) AND ("curettage"[MeSH Terms] OR "surgical"[All Fields] OR ("resection"[All Fields] AND "ameloblastoma"[All Fields]) OR "ameloblastomas"[All Fields])
Comments on
The Evidence
Validity: There exist no randomized trials that objectively address the comparative efficacies of conservative versus radical treatment for ameloblastoma. However, the clear trend in retrospective assessments is a higher recurrence rate associated with conservative interventions when compared against radical intervention. Perspective: Ameloblastomas are benign, slow growing odontogenic tumors with an aggressive potential for local invasion and recurrence. The World Health Organization (WHO) further characterizes ameloblastomas based on their histological characteristics as: solid/multicystic (follicular or plexi-form), extraosseous/peripheral, desmoplastic and unicystic. Extraosseous/peripheral and unicystic tumors appear to have a lower rate of recurrence compared to solid/multicystic and desmoplastic tumors. Accordingly, some recommend that extraosseous/peripheral and unicystic tumors are more amenable to conservative surgical management.
Applicability While the histological classification is an important parameter for deciding for or against conservative therapy, deliberate and regular follow-up is mandatory regardless of the intervention employed. Radical resective surgery to manage ameloblastoma is associated with a lower rate of recurrence compared to conservative interventions.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (Oral Surgery)
Keywords Ameloblastoma; enucleation; resection; recurrence
ID# 3153
Date of submission: 03/22/2017spacer
E-mail patelmm@livemail.uthscsa.edu
Author Meet Patel
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Michaell Huber, DDS
Faculty mentor/Co-author e-mail HuberM@uthscsa.edu
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