How is peripheral ameloblastoma managed?

Management of Peripheral Ameloblastoma

The standard treatment for peripheral ameloblastoma is conservative surgical excision with a small margin of healthy tissue to minimize recurrence while preserving function and aesthetics. 1

Diagnosis and Evaluation

• Peripheral ameloblastoma is a benign odontogenic tumor that appears in the gingiva and mucosa of the tooth-bearing areas of the jaws without invasion or involvement of underlying bone 2, 1
• Histopathological evaluation, computed tomography, and incisional biopsy are essential for confirming the diagnosis and determining the extent of the lesion 3
• Multidisciplinary review involving oral surgeons, pathologists, and prosthodontists is recommended for comprehensive treatment planning 3

Surgical Management

Primary Treatment

• Conservative surgical excision with a small margin of healthy tissue is the treatment of choice for peripheral ameloblastoma 2, 1
• Unlike intraosseous ameloblastomas, peripheral variants do not require aggressive resection due to their non-invasive nature 4
• The excision should include the base of the lesion with a narrow margin of clinically normal tissue to ensure complete removal 1

Surgical Considerations

• Peripheral ameloblastomas should be distinguished from intraosseous solid/multicystic and unicystic types, as they require different treatment approaches 4
• Unlike intraosseous ameloblastomas which may require segmental resection, peripheral variants can be managed with more conservative approaches 5
• Careful attention must be paid to ensure complete removal, as incomplete excision is the primary cause of recurrence 1

Follow-up and Monitoring

• Long-term follow-up of at least 10 years is recommended to monitor for potential recurrence 2
• Regular clinical examinations should be scheduled more frequently in the first few years post-surgery 1
• Recurrence is unlikely if complete removal with appropriate margins is achieved 1, 4

Rehabilitation

• Post-surgical prosthetic rehabilitation may be necessary depending on the extent of the excision 3
• Functional and aesthetic outcomes are generally satisfactory with conservative management 5
• In cases where larger excisions are required, prosthetic rehabilitation should be considered to improve speech, mastication, and aesthetic appearance 3

Common Pitfalls and Considerations

• Misdiagnosis as other gingival lesions may lead to inadequate treatment 1
• Incomplete removal is the primary cause of recurrence, emphasizing the importance of appropriate surgical margins 1
• Distinguishing peripheral ameloblastoma from other variants is crucial, as more aggressive forms require more extensive surgical approaches 4, 5
• Balancing complete tumor removal with preservation of function and aesthetics is essential for optimal outcomes 3, 5