Ameloblastoma is a benign but aggressive odontogenic tumor that commonly affects the jaw (mandible or maxilla). Due to its invasive nature and the potential presence of residual tumor tissue, the choice of surgical method is critical in determining clinical outcomes and postoperative quality of life. The two main approaches are radical surgery (resection/segmental resection) and conservative surgery, one of which is the stage 1 dredging method.
Case Description
A study conducted by a student of the Faculty of Dentistry, Universitas Gadjah Mada (UGM), Marsono, under the supervision of Prof. Dr. drg. Setyo Harnowo, Sp.BM., FICD., described two cases of mandibular ameloblastoma:
- Case 1 involved a 36-year-old male who underwent left mandibular segmental resection, followed by rehabilitation with artificial jaw reconstruction using a bridging plate and an autograft from the rib bone (costae). After approximately one year, a fistula developed in the symphysis and left mandibular angle regions, requiring reoperation.
- Case 2 involved a 43-year-old female who underwent a conservative approach using stage 1 dredging, consisting of tumor enucleation and histopathological examination without major resection. The initial results were favorable; however, further procedures were still required to ensure complete removal of residual tumor tissue.
Comparison of Strategies: Radical vs. Conservative
The following is a comparison of the important aspects between the two methods used in the case:
| Aspect | Radical Surgery (Segmental Resection) | Conservative Surgery (Stage 1 Dredging) |
|---|---|---|
| Complete Tumor Removal and Safety Margins | More likely to remove the entire tumor due to extensive resection and wider margins. | Higher risk of residual tumor if not performed thoroughly; reoperation may be required if remnants remain. |
| Jaw Structure & Aesthetics | Requires major reconstruction (autograft, bridging plate) to restore jaw contour; higher risk of deformity and complications. | Preserves most of the jaw structure; lower risk of deformity if successful, but final outcomes may be suboptimal if residual tumor persists. |
| Recovery Time and Complications | Longer and more complex recovery; fistula formation occurred as a complication one year after resection in the reported case. | Recovery may be faster with lower invasiveness; initial results were good, but close monitoring and possible reoperation are required. |
| Rehabilitation Needs | Requires extensive structural reconstruction using plates, bone grafts, or mesh. | Less need for major reconstructive materials if successful; continued observation and follow-up procedures may still be necessary. |
Clinical Considerations in Choosing the Surgical Method
Several considerations emerged from the report:
- Tumor size and location: Large tumors or those that have destroyed critical bone structures may be better managed with resection.
- Risk of residual tumor: In conservative approaches such as stage 1 dredging, residual tumor tissue must be carefully monitored, as it can lead to recurrence.
- Reconstructive capability: If resection is performed, adequate facilities and expertise in reconstruction (grafts, plates, mesh) are essential to achieve good functional and aesthetic outcomes.
- Patient tolerance for major surgery: Patients in good general condition may tolerate radical surgery, whereas high-risk patients may benefit more from a conservative approach.
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Based on the two cases presented in the thesis:
- Radical surgery (segmental resection) provides more definitive tumor removal but is more invasive, requires reconstruction, and carries a higher risk of complications.
- Conservative surgery using stage 1 dredging can be an alternative, especially for relatively small tumors or for patients wishing to avoid major surgery; however, it requires strict monitoring and possible reoperation to remove residual tumor tissue.
References
MARSONO, Prof.Dr.drg. Setyo Harnowo, Sp.BM.,FICD., Tinjauan klinis dan radiologis kasus Ameloblastoma mandibula yang dilakukan tindakan reseksi dan yang dilakukan dengan tindakan metode Dredging tahap 1 :: Laporan kasus, https://etd.repository.ugm.ac.id/penelitian/detail/25235
Author: Rizky B. Hendrawan | Photo: Freepik
