Management of primary ameloblastoma of the jaw: a 15 years' experience.

Aim: The aim of this retrospective study was to describe our 15-year experience in the management of primary ameloblastoma of the jaw.

Methods: We investigated 26 patients who had undergone surgical treatment for a single lesion, comprising six lesions of the maxillary bone and 20 tumors of the mandible: 73% had a radiolucent multilocular lesion; 23% a unicystic lesion; and 4% had an extraosseous form of the tumor. The smaller lesions (diameter <3 cm) were treated by conservative approaches; the larger lesions required radical surgical resection. Two groups were created according to whether the patients had received conservative or aggressive surgery.

Results: The recurrence rate was estimated for a minimum duration of follow-up of 10 years; 23 patients met this criterion. Tumor recurrence was observed in all the patients who had undergone conservative surgery but not in those who had received aggressive surgery. Comparison of the healing curves (log rank test) showed statistically significant differences between the two groups (P=0.4522).

Conclusion: All recurrent lesions were ameloblastomas primarily treated with enucleation and/or curettage. On the basis of our study we suggest that when an ameloblastoma is small it can be removed with a marginal aggressive resection with a 1-cm margin beyond the radiological limit; in contrast, if an ameloblastoma is larger than 3 cm we suggest aggressive segmental resection of lesion with a margin 1.5-2-cm beyond the radiological limits.