AMELOBLASTOMA OF MAXILLA AND MANDIBLE

M. K. SEHDEV,MD," A. G. Huvos, M D , ~E. W. STRONG,MD,"

F. P. GEROLD,
MD,* AND G. W. WILLIS, M D ~

Results of various treatment modalities in 72 patients with ameloblastoma of

mandible and 20 patients with ameloblastoma of maxilla are analyzed. Con-
troversial methods of treatment are discussed to arrive at a semblance of ra-
tional management. T t was found that: 1. Curettage was followed by local
recurrence in 90% of mandibular and all maxillary ameloblastomas; 2. Sub-
sequent resection could control SO% of mandibular but only a fraction of
maxillary recurrences; 3. Marginal resection, in a few selected cases, might
control primary cases of mandibular ameloblastoma but is not a useful pro-
cedure for recurrent mandibular ameloblastoma; 4. External radiation therapy
was ineffective in controlling ameloblastoma but did not seem to adversely
affect prognosis even after subsequent resection; and 5. Distant metastases, al-
though rare, occurred in 7 patients.

I N 1885 MALASSEZINTRODUCED THE TERM

adamantinoma to denote the odontogenic
tumor which had been recognized by Cusack
in 1827 and described later by Falksson.2JJ2
Ivey and Churchill in 1930 changed the name
to ameloblastoma.10 T h e W.H.O. Monograph
on International Histologic Classification of
Tumors defines benign and malignant amelo-
blastomas separately.9 These can be combined
to state that an ameloblastoma is an invasive,
potentially malignant neoplasm consisting of
proliferating odontogenic epithelium sup-
ported by fibrous stroma. T h e possible sources
of cells forming these lesions have been col-
lected and summarized by Hinds et al.7 and
Gorlin et a1.6 as: 1. epithelial Iining of an
odontogenic cyst; 2. dental lamina or enamel
organ; 3. stratified squamous epithelium of
the oral cavity; or 4. displaced dental epithe-
lial remnants (accounting for tumors arising
in soft tissues without bone involvement) .
Zegarelli showed that in mice, the point of
origin of ameloblastoma was the embryonal
cells comprising the outer epithelial layer of
the enamel organ.22 Smith believes that the
tumor arises from basal cells of the oral epi-
thelium or from cells that have undergone
differentiation to mimic ameloblasts.18
Presented at the Twenty-Sixth Annual Meeting of
The James Ewing Society, Louisville, Kentucky, April
26-28, 1973.
From the Head and Neck Service of the Department
of Surgery* and the Department of Pathology,t Mcmo-
rial-Sloan Kettcring Cancer Center, New York.
Address for reprints: A. G. Huvos, MD, 444 East
68 Street, New York, N. Y. 10021.
Received for publication August 28, 1973.
324
Although only about 1yo of odontogenic tu-
mors and cysts are estimated to be amelo-
blastomas,6 the lesion has continued to fasci-
nate pathologists because of diversity af
microscopic features, and surgeons because of
its frequent defiance to complete eradication.
T h e purpose of this study is to analyze the re-
sults of different treatment modalities and to
examine results of treatment of recurrent ame-
loblastomas of maxilla and mandible seen at
Memorial-Sloan Kettering Cancer Center.
MATERIAL
Clinical records and pathologic material of
all odontogenic tumors diagnosed as adaman-
tinoma or ameloblastoma during the years
1920-1970 at Memorial-Sloan Kettering Can-
cer Center were reviewed. According t o the
W.H.O. criteria for diagnosis of this neo-
plasm, 74 patients had ameloblastoma of the
mandible and 21 of the maxilla. Two patients
with mandibular and 1 with maxillary amelo-
blastoma were seen in consultation only and
so are not included in this analysis. T h e re-
maining 72 patients with ameloblastoma of
mandible and 20 patients with ameloblastoma
of maxilla form the basis of this study (Table
1). All other odontogenic tumors were elimi-
nated.
Grossly, the typical lesion was firm, yellow,
with areas of necrosis and cystic degeneration.
Some were predominantly cystic, while others
were solid (Figs. IA-D). T h e tumors were
multilobular with bosselations and exhibited
No. 2 AMELOBLASTOMA
* Sehdev el al. 325
a three-dimensional pattern of spread within tions of these tumors revealed an overlap in
cancellous bone. the patterns of neoplastic growth. Squamous
Several histologic variants of growth pat- metaplasia was especially associated with the
terns were noted. T h e most common types follicular and granular cell varieties (Figs.
were follicular and plexiform. Multiple sec- 2A-C). No direct relationship between the
various histologic patterns and prognosis
could be established.
1. Incidence and Location of Ameloblastoma,
TABLE
Memorial Hospital, 1920-1970 Mandible
Locntion/Sex NO. Total
Of the 72 patients (33 male and 39 female)
Mandible with ameloblastoma of mandible, 43 (60y0)
Male 33 had received their initial treatment elsewhere.
Female 41 74
Only 29 (40%) were seen as primary cases.
Maxilla T h e youngest patient was a 10-year-old girl
Male 11 and the oldest a 78-year-old man. Almost two-
Female 10 21 thirds of the patients (49) were between 31-60
3 cases consultation only. years of age (Fig. 3). T h e duration of symp-

FIG. 1A. Cystic ame-

loblastoma of mandi-
ble.

FIG. 1B. Cystic amelo-

blastoma of mandible
with solid areas.
 CANCERFebruary 1974
toms is shown in Fig. 4.Since the various signs
and symptoms of ameloblastoma of mandible
are adequately described elsewhere,5,l3J4Jr
they will not be analyzed here.
External radiation Therapy: Nine patients
with ameloblastoma of mandible were treated
by external irradiation (Table 2). T h e size of
lesions treated ranged from 3-8 cm with an
average of 4.7 cm. T h e duration of symptoms
varied from 1 month to 5 years before treat-
ment. Three of these patients had persistent
disease upon completion of external radiation
therapy. T h e recurrence of the tumor in one
of these three was not treated aggressively be-
cause of poor general condition. T h e other
two patients underwent segmental mandibu-
lar resections and are alive free of disease 25
and 47 years respectively. Six of the nine pa-
tients initially responded to the external ra-
diation therapy but developed clinically ob-
vious recurrence 2-8 years later. All of them
were treated by either partial or hemi-mandi-
bulectorny. Four are alive, free of tumor,
12-24 years since their resections. One died
during operation, another died 2 months later
of osteomyelitis of jaw. External radiation
therapy was employed in the treatment of
mandibular ameloblastomas during the years
1921-1951 when the present day sophisticated
supervoltage radiation equipment was not
available.
Curetlage: Curettage was the initial treat-
ment in 32 patients (27 elsewhere, 5 at M.H.)
Only 3 patients so treated have remained free
of recurrence 4, 7, and 22 years respectively
after surgery. T h e first patient was lost to fol-
lowup with no evidence of recurrence 4 years
after curettage. I n 11 patients there was al-
most immediate evidence of persistent tumor
at the site of curettage. Eighteen patients de-
Fic. 1C. Predominantly solid
ameloblastoma of mandible with
peripheral cystic degeneration.
FIG. 1D. Solid ameloblastoma
of mandible with extension into
ascending ramus. Cortical bone
erosion is prcsent.
No. 2 -
AMELOBLASTOMASehdev et al. 327

FIG. 2A (left). Typical plexiform type of amelohlastoma of mandible (H&E, ~ 2 0 ) .

FIG. 2B (right). Plexiform type of ameloblastoma with prominent areas of granular cells
(H&E, X20).

FIG.2C. Metastatic amelohlastoma in lung exhibiting squamous differentiation. Same patient as

in Fig. 2B (H&E, X50).
328
CANCER
Age in Years
FIG. 3. Age and sex incidence in 94 patients with
ameloblastoma.
veloped recurrence 3 months to 12 years later.
T h e size of recurrent ameloblastoma varied
from 2.5 cm to 12 cm (average size 5.4 cm).
Management of persistent ameloblastoma:
Three patients with persistent mandibular
ameloblastoma after curettage were treated by
external radiation (Fig. 5). Two of these had
radon seed implantation in addition to exter-
nal therapy. One died of extensive local dis-
ease 23 years later, one was lost to followup
with disease 3 years later, and the third devel-
oped cheek and bone necrosis, but is free of
recurrence 23 years after treatment.
Five patients with persistent tumor were
treated by either marginal, segmental, or hemi-
mandibulectomy. Three of these are free of
recurrence. One patient is alive with disease
and the other dead of extensive local recur-
rence.
Two patients were not treated for their re-
TABLE
2. Ameloblastoma of Mandible Treated b y External Radiation (9 Cases)*
Age/Sex Year treated
25 P t 1921
48 0 1927
30 0 1933
50 P 1940
49 3 1944
19 Pt 1947
50 0 1948
47 3 1951
* 1 Patient had residual disease; no subsequent Rx L F U * 3 yrs.
t Residual disease
* LFU = Lost t o followup; NED = No evidence of disease.
February 1974
VOl. 33
currence because of other conditions-ad-
vanced carcinoma of cervix and advanced
carcinoma of urinary bladder.
Only one patient treated by recurettage is
alive without disease, 6 years post-recurettage.
Management of recurrent am elo b lust oma :
T h e results of resections for recurrent amelo-
blastoma after curettage in 18 patients are
summarized in Fig. 6. Two patients treated
by marginal mandi bulectomy had recurrent
tumors within 1-2 years; one was controlled
by subsequent hemi-mandibulectomy, while
the other had multiple procedures including
orbital exenteration and palliative cryosurgery
for recurrences which have continued to pro-
gress over 28 years.
Six patients treated by segmental mandibu-
lectomy are free of disease 2-28 years since
surgery. Eight patients were treated by hemi-
mandibulectomy; one died with no evidence
of disease 1 year later; two were lost to fol-
lowup at 2 years and 12 years respectively.
Only one of these eight patients has developed
recurrence 8 years later. Of two patients
treated by extended hemi-mandibulectomy,
one died of disease 10 years later and the
other is alive and well 20 years later.
Mandibzilectomy: Thirty-one patients with
ameloblastoma of mandible were treated by
either marginal, segmental, or hemi-mandibu-
lectomy (Table 3). Two patients were treated
by marginal resection for lesions which meas-
ured 2 cm and 5 cm, respectively. Both are
alive and free of disease 5 and 18 years respec-
tively after surgery. Segmental mandibulec-
torny was performed in 23 patients whose le-
sions varied in size from 2-12 cm, averaging 5
cm. Five of these patients developed recurrent
tumor 2 months to 24 years after operation.
T h e recurrences were small and successfully
Recurrence Subsequent
(years later) mandibulectom y Result
t Segmental N E D * 47 yrs.
2.5 Hemi N E D 23 yrs.
6 Segmental Op. death
3 Hemi Died osteo. 3 mos.
7 Hemi N E D 24 yrs.
t Segmental N E D 25 yrs.
8 Segmental N E D 12 yrs.
2 Segmental N E D 12 yrs.
No. 2 AMELOBLASTOMASeizdev et al. - 329
16 Yearsalter Seurn$ry Tnatmnt
0 Mandible (72 Cases)
B Maxilla (20Cases

n -
- NED
NED
NED
NED
Segmental NED
Nt D
-- DIED NED
LFU NED
NED
RLC
LfU NED
NED
Hem1 DIED NED
NED

Hemi + pttial WD
Months Years Recorded Maxillectomy NED

FIG. 4. Duration of signs and symptoms of patients FIG. 6. Managcment of recurrent lesions after curct-
with ameloblastoma. tagc in ameloblastoma of mandible.

treated by further resections. Six patients un-
derwent hemi-mandibulectomy. Their lesions
were somewhat larger, the size varying from 3
cm to 9 cm, averaging 6 cm. They are all alive
and free of disease.
Maxilla
Of 20 patients with ameloblastoma of max-
illa treated at Memorial Hospital, 9 had pri-
mary treatment elsewhere. T w o patients were
referred here after biopsy. Eleven patients
(55%) were male and 9 (457&) female, corre-
sponding to an over-all ratio of 52 males to 48
females i n the collected statistical data of
Rockoff.IF T h e size of lesion was recorded
as 3-10 cm with an average diameter of 5 cm.
Since signs and symptoms of ameloblastoma
of maxilla are not mentioned in most of the
reports, brief discussion of these is relevant
here.
Swelling, either of cheek, gingiva, or hard
palate was the chief complaint in 19 patients.
Years after Secondary Treatment
0 2 4 6 8 10 12 14 16
I I I I I I
External RT
External RT
+Implant
- LFU with Dixase
Marginal
&Section
- REC
Hemimandib- NED
ulectomy
Re-Curettage IFU NED
No Treatment 2 Patients
FIG. 5. Managcment of persistent ameloblastoma of
mandible after curettage. LFU = Lost to followup;
REC = Recurrence; NED = No evidence of disease;
DOD = Died of diseasc.
Pain was reported by 8 patients, all of whom
had recurrent tumor. Nasal obstruction and
epistaxis occurred only in previously treated
patients. I n 14 patients the duration of symp-
toms was less than 1 year. T h e mass was clini-
cally described as cystic, solid, or ulcerated.
Seven of the primary cases had radiologic eval-
uation of their paranasal sinuses. T w o showed
calcifications in cystic tumors; 3 showed opac-
ity of maxillary antrum; and 2 showed de-
struction with opacity of the antrum.
Treatment: Radiation therapy, curettage,
and partial or radical maxillectomy, were the
modalities of treatment employed (Table 4).
T w o patients who were treated (one in 1936
and one i n 1937) with external radiation ther-
apy, had recurrence of their tumors; one after
6 months, the other after 15 years. Both subse-
quently underwent successful partial maxillec-
tomy and died without evidence of recurrence
12 years postoperatively.
Recurrences occurred in all I I patients
treated by curettage. Management of these pa-
tients is summarized in Fig. 7. Of the three
18 20 22 24
I I I I i I I
patients treated by radical maxillectomy, two
were cured, and the third died of massive
DOD
local recurrence with proven pleuro-pulmo-
NO
nary metastases. Partial maxillectomy was
done in two cases; one patient had recurrence
7 years later, and the other is free of disease
Died
after 4 years. Five patients were treated by re-
FED peated curettage. One patient received exter-
LFU FED nal radiation therapy, and died of disease 1
WD
year later.
T h e most effective treatment modality ap-
pears to be adequate resection (Table 4).
Seven of the 11 primary cases were treated by
resection at Memorial Hospital. Six of these
had partial and 1 radical maxillectomy. Five
3 30 February 1974
CANCER VOl. 33

TABLE
3 . Over-all Results of Treatment in Ameloblastoma of Mandible
Secondary treatment (resections)
Initial No. of Recurrence Controlled
treatment patients No. % No. treated No. %
External R T 9 9 100 8 7” 87
Curettage 32 29 90 27 21 77
Resection
Marginal 2 - 0
Segmental 23 5 22 100
Henti- 6 -
-_ __
Twr.4~ 72 43
* Operative death.

of the patients treated by partial maxillec- tooth extraction, trauma, or infection at the
tomy are alive and free of disease 9-18 years site of ameloblastoma.15 Georgiade et al. noted
postoperatively. T h e sixth patient died of that ’70% of their patients had had tooth
pneumonia 2 months after surgery. T h e pa- extraction, trauma, or infection at the site of
tient who had radical maxillectomy as the ini- ameloblastoma.4 I n 14 of 18 patients with
tial treatment of a large 6 cm tumor is alive history of tooth extraction, diagnosis of amelo-
and well at 18 years. blastoma was made only after the removal of
an impacted tooth resulted in nonhealing of
DISCUSSION the wound, sinus formation, or further growth
of the tumor. Because there is no other abso-
Ameloblastoma of mandible has been dis- lute way of making diagnosis of ameloblas-
cussed extensively in the literat~re.5.~3,1~,17.20toma, careful histologic examination of the
Since ameloblastoma of maxilla forms only lining of all odontogenic cysts has been re-
about 20y0 of the total reported cases,16 and peatedly empha~ized.l,l~,~Q,*0 Five examples of
each series has only a few patients, the natural ameloblastoma developing in the wd1 of the
history of maxillary ameloblastoma has, so dentigerous cyst were seen in this series. None
far, been unclear. Vitriolic arguments for and was associated with primordial cysts.
against “conservative” and “radical” excisions Once the diagnosis of ameloblastoma has
abound with no clearcut criteria for prefer- been established, it may be difficult to decide
ence of either. I n an effort to arrive at a sem- on the best form of therapy. T h e results of
blance of rational management, analysis of curettage obtained in 32 patients with amelo-
patients treated over 50 years is presented, blastoma of mandible and 11 patients with
and some of the controversial points are ex- ameIoblastoma of maxilla have certainly indi-
amined in light of data obtained. cated the ineffectiveness of this form of ther-
Eighteen of the 92 (20%) patients seen apy in achieving tumor eradication. Only 3 of
with ameloblastoma gave a history of tooth 32 patients have stayed free of recurrence after
extraction without recognition of presence of repeated curettage for mandibular ameloblas-
ameloblastoma at that time. Sixty-five per- toma-a cure rate of only 10%. Subsequent
cent of Rankow’s patients gave a history of treatment by segmental or hemi-mandibulec-

TABLE
4. Over-all Results of Treatment in Ameloblastoma of Maxilla
Secondary treatment (resections)
Initial No. of Recurrence Controlled
treatment patients No. % No. treated No. %
External R T -7 2 100 2 2 100
Curettage 11 11 100 11 4 36
Resection
Partial 6 * 0
Radical 1 _ 0
-_ __ -_ -- __ __
-_ TOTAL 20 13 0 13 6 46
* 1 died of pneumonia N E D 2 months later, 1 LFL. after discharge.
No. 2 AMELOBLASTOM
A Sehdeu et al. - 33 1
Yearsifter Ssmnaly Tnaimnt
0 2 4 6 7 8 1 2 1 4 1 6 1 8 Z l 2 2 2 4 X 2 8 3 l
T h e opening of the maxillary antrum to di-
I I I I I I I I I I I I I I I I rect, and clinically invisible, spread of amelo-
Radi~l
Marilledomy
DOD
NED blastoma by currettage, perhaps contributes to
Dled NED
delay in early recognition and hence adequate
PtRltl -NED
treatment of recurrence. Once the tumor
Marlllactomy

Re-curettage
-
- RC
DDD
RC LFU

NED
~

breaks through the maxillary antrum, spread

to the ethmoid air cells, pterygomaxillary
REC
fossa, temporal fossa, and base of brain makes
External
RT
- DOD
REC
complete excision impossible. Radical maxil-
lectomy is avoided by the surgeon and not
FIG. 7. Treatment of recurrence after curettage in
ameloblastoma of maxilla. readily acceptable to the patient, occasioning
further delay. Five of 1 1 curettage failures of
tomy in 21 patients resulted in a recurrence maxillary ameloblastoma had symptoms of
rate of 20% (4 patients). This result is likely nasal obstruction and epistaxis before recur-
to worsen because at least three of these pa- rence was suspected by the doctor who was fol-
tients have had followup periods of less than 2 lowing the patient regularly at frequent inter-
years. Even then, it is interesting to note that vals. Only five of I1 curettage failures were
this corresponds to a recurrence rate of 22% felt to be surgically resectable when seen. This
in patients who were treated by segmental data supports the statement that the only ra-
mandibulectomy as primary therapy! A cure tional treatment of ameloblastoma of maxilla
rate of 1 0 0 ~ owas reported by Rankow by is complete removal, en bloc, with a margin of
hemi-mandibulectomy after curettage fail- healthy tissue.
ures.15 These data support the statement T h e conclusion can therefore be derived
made by Stout and Lynch19 that the diagnosis that whereas it may not be disastrous to try
of ameloblastoma does not necessarily warrant curettage initially in ameloblastoma involving
an immediate resection of the mandible since mandible, it should be vehemently con-
subsequent curability by resection is not less- demned for ameloblastoma of the maxilla
ened by previous conservative procedure. where a prompt adequate resection should be
Young and Robinson21 in 1962 reported on carried out. Shatkin’s words would fit this con-
ameloblastoma in children aged 0-9 years. clusion perfectly: “The so-called ‘conservative’
Their conclusion, after reviewing 3 1 reported treatment by curettage, at best, disfigures the
cases, was that ameloblastoma in children patient and, at worst, kills him, whereas the
might be a different type of lesion than that so-called ‘radical’ treatment by adequate exci-
seen in adults. Pathologists have reported that sion conserves the patient’s appearance, func-
ameloblastomas in children might be odonto- tion and life.”l7 T o this we can unequivo-
mas or mixed odontogenic tumors. There was cally add, particularly when applied to
only one child, aged 10 years, with ameloblas- ameloblastoma of maxilla.
toma of mandible in our series. Review of the Marginal resection of mandible was done in
histologic slides revealed that this lesion was a two primary cases with ameloblastomas esti-
plexiform type of ameloblastoma. This pa- mated to be about 2 and 5 cm in size. Both of
tient was treated by curettage and has stayed these patients are alive and free of disease at 8
free of recurrence 7 years after surgery. Con- and 9 years respectively. Marginal resection
servatism, presumably curettage and local ex- done in three patients who had recurrence
cision, in management of ameloblastomas in after curettage, however, resulted in recur-
the age group 0-9 years was recommended as rence within 2 years in all three patients.
treatment by Young and Robinson.21 Smith, after reviewing available data on ame-
T h e results of curettage are very different loblastomas, suggested that although there is
and disastrous for maxillary ameloblastoma. no place for irradiation, radium implants, cur-
Of the 11 patients treated by curettage, the ettage, or sclerosing agents, segmental resec-
tumor recurred in all ( l O O ~ o ) . Seven of these tions of the jaw are also perhaps not justified
patients (63%) are either dead of or alive with with smaller ameloblastomas. In these he rec-
massive local recurrences. Of the four patients ommended marginal resections.18 Lending
who are alive and well, the tumor could be weight to this is Kramer’s finding” that while
controlled only by radical maxillectomy in there is diffuse invasion of the cancellous
two, partial maxillectomy in one, and re- spaces of the bone marrow by fingerlike
peated curettage in the fourth. projections, the tumor tissue does not invade
332 February 1974
CANCER
the Haversian systems of compact bone. Thus,
although the compact bone of the lower bor-
der of mandible may be eroded it is unlikely
to be invaded. He, therefore, concludes that in
the treatment of these lesions, if it is thought
desirable on general clinical and surgical
grounds to save this part of the bone, then as
a calculated risk the cIinical and radiologic
margin of the lesion in this area may be re-
garded as the true margin." It can, therefore,
be stated that marginal resections in small pri-
mary cases of ameloblastomas may give satis-
factory results but that its use in curettage
failure was followed by 100% recurrence rate
in three patients in whom it was tried.
Reconstruction after segmental resection of
mandible was performed in 12 of 32 patients
using autogenous bone or metal prosthesis. I n
only one patient infection developed and the
steel mesh had to be removed. All other recon-
structions were successful.
Nine of 92 patients died because of uncon-
trolled ameloblastoma. Four of these showed
pulmonary metastases clinically before death,
but died as a direct consequence of uncon-
trolled local tumor.
Seven patients with ameloblastoma of the
jaw developed distant lesions, consistent with
metastasis. Five patients showed pleuro-pul-
monary metastasis, histologically proven in
four (Table 5). All five of these patients had
massive locally recurrent ameloblastoma in
spite of multiple attempts at eradication. T h e
metastatic deposits had a comparatively more
TABLE
5. Results of Treatment in Five Patients with Pulmonary Metastases
Treatment
Age a t onset Elsewhere
19 d' Tooth extraction
21 0 Curettage
Excision X 2
RT
60 0" Curettage X 2
44 8 Mandibulectorny
45 0" Curettage X 2
Vol. 33
undifferentiated appearance although struc-
turally these resembled the primary tumor in
their histologic pattern. Epidermoid carci-
noma in association with ameloblastoma was
not noticed in any of these.
Two additional patients had clinical evi-
dence of metastases to organs other than
lungs, i.e. liver and bone (Table 6). They had
no evidence of local recurrence at time of
death.
SUMMARY
Results of various treatment modalities in
72 patients with mandibular and 20 patients
with maxillary ameloblastoma are analyzed.
Certain conclusions are reaffirmed, others
emerge anew. All of these may be summarized
as :
1. Curettage was followed by local recur-
rence in 90% of mandibular and 100% of
maxillary ameloblastomas.
2. Whereas mandibular resection may con-
trol the recurrence after curettage in most pa-
tients, maxillary resection for recurrence, even
when radical, is usually ineffective or impossi-
ble.
3. Whereas marginal resection may control
the small primary mandibular ameloblastoma,
it was followed by relatively prompt recur-
rence whenever it was performed for curettage
failure.
4. Whereas resection offered a good chance
Memorial Hospital Survival after onset
Hemimandibulectomy 4 months
Excision X 2
RT 39 years
Radical inaxillectomy
Excision recurrence 10 years
Excision metastases
Mandibulectomy
RT 34 years
Mandibulectomy
Multiple excisions
Orbital exenteration 28 years-Living
Cryosurgery X 16
No. 2
AMELOBLASTOMA Sehdev et al.
TABLE
6. Results of Treatment in Two Patients with Non-Pulmonary Metastases
Treatment
Age a t onset Elsewhere Memorial Hospital
55 3 Maxillectomy None
RT
36 3 Curettage Implant
Right mandibulectomy
of cure after recurrence following curettage,
radiation therapy or repeated curettage only
served as palliation, with no control over
spread of the tumor.
5. Whereas external radiation therapy ap-
pears to be ineffective in controlling the
tumor, early recognition of therapeutic failure
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333
Survival after onset Site of metastases
2 years Lumbosacral spine
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