What is the treatment for Ameloblastoma?

In short, the treatment is surgery. But what kind of surgery? The traditional procedure is removal of the entire tumor with 1-2 centimeters of bone in every direction. The reason for the extra bone removal is to decrease the risk of the tumor coming back. Even though we have a good idea of where of the edges of the tumor are located based on x-rays, there can be tumor cells further into the bone that we cannot see with our x-rays.

Over the years, some surgeons have tried to treat ameloblastomas more conservatively. Instead of removing extra bone around the edges of the tumor, the surgeon peels the tumor off the bone. The problem with this method is there is no way to know if microscopic cells have been left behind in the bone. If any tumor has been left behind, then recurrence is highly probable. To be fair, when removing extra bone around the tumor, there is still no guarantee of removing all the cells, although the risk of recurrence is much lower.

Even though we have a good idea of where of the edges of the tumor are located based on x-rays, there can be tumor cells further into the bone that we cannot see with our x-rays.

It is worth commenting on one subtype of ameloblastoma called the "Unicystic Ameloblastoma." These tend to occur in younger patients, often teenagers. There is some research that suggests these can be treated more conservatively by peeling the tumor off the bone. The problem is that some areas of the tumor might be Unicystic, while other areas of the tumor are not, and this information is usually not known until it is already removed.

What happens to the defect left from removing the tumor?

Removing the tumor is usually a straight-forward procedure. The more difficult part is deciding on the best way of reconstructing the missing bone and teeth. Much of this decision process involves the experience and training of your surgeon. These decisions include immediate or delayed bone reconstruction, vascularized (fibula) or non-vascularized bone or tissue engineering (BMP), immediate or delayed dental implants, and other decisions. Not all surgeons are trained in all methods of reconstruction. In general, it's best to see a surgeon experienced in ALL methods of reconstruction to make sure you have all options available.