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Surgical Treatment of Ameloblastoma: How Does It Impact the Oral Health-

Related Quality of Life? A Systematic Review

Article  in  Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons · March 2022
DOI: 10.1016/j.joms.2022.03.003

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Surgical treatment of ameloblastoma: How does it impact the oral health-related

quality of life? A systematic review

Wladimir Gushiken de Campos, MSc, Gustavo Luiz Alkmin Paiva, DDS, Camilla
Vieira Esteves, PhD, André Caroli Rocha, PhD, Pedro Gomes, PhD, Celso Augusto
Lemos Júnior, PhD
PII: S0278-2391(22)00179-3
DOI: https://doi.org/10.1016/j.joms.2022.03.003
Reference: YJOMS 60032

To appear in: Journal of Oral and Maxillofacial Surgery

Received Date: 4 November 2021

Revised Date: 22 February 2022
Accepted Date: 3 March 2022

Please cite this article as: Gushiken de Campos W, Alkmin Paiva GL, Esteves CV, Rocha AC, Gomes
P, Lemos Júnior CA, Surgical treatment of ameloblastoma: How does it impact the oral health-related
quality of life? A systematic review, Journal of Oral and Maxillofacial Surgery (2022), doi: https://
doi.org/10.1016/j.joms.2022.03.003.

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© 2022 Published by Elsevier Inc on behalf of the American Association of Oral and Maxillofacial
Surgeons
 Surgical treatment of ameloblastoma: How does it impact the oral

health-related quality of life? A systematic review

Wladimir Gushiken de Campos1, MSc; Gustavo Luiz Alkmin Paiva2, DDS;

Camilla Vieira Esteves3, PhD; André Caroli Rocha4, PhD; Pedro Gomes5, PhD;

and Celso Augusto Lemos Júnior6, PhD

1. PhD student. Department of Oral Medicine, Faculdade de Odontologia,

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Universidade de São Paulo (São Paulo/Brazil). E-mail:

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wgushiken@hotmail.com Phone: +551130917901 ORCID: 0000-0002-

2086-3087
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2. Postgraduate student. Department of Oral Medicine, Faculdade de
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Odontologia, Universidade Estadual de Campinas (São Paulo/Brazil). E-

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mail: gustavo.alkminpaiva@gmail.com Phone: +551130917901 ORCID:

0000-0002-9646-4998
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3. Professor. Department of Oral Medicine, Faculdade de Odontologia,

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Universidade de São Paulo (São Paulo/Brazil). E-mail:

camilla.santos@alumni.usp.br Phone: +551130917901 ORCID: 0000-

0001-9673-2756

4. Professor. Department of Dentistry, Clinics Hospital, University of Sâo

Paulo (São Paulo/Brazil). E-mail: andcaroli@uol.com.br Tel.: +55 11

3091-7883 ORCID 0000-0003-0070-0640

5. Professor. Laboratory for Bone Metabolism and Regeneration, Faculty of

Dental Medicine, University of Porto, 4200-393 (Porto/Portugal). E-mail:

 pgomes@fmd.up.pt Phone: +351220901100 ORCID: 0000-0001-5365-

2123

6. Professor. Department of Oral Medicine, Faculdade de Odontologia,

Universidade de São Paulo (São Paulo/Brazil). E-mail: calemosj@usp.br

Phone: +551130917901 ORCID: 0000-0002-3372-6719

Corresponding author:

Wladimir Gushiken de Campos

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Stomatology Department, School of Dentistry, University of Sao Paulo

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Avenida Prof. Lineu Prestes, 2227 - Butantã, São Paulo - SP, Brazil
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Tel.: +55-11-2648-8148 – E-mail: wgushiken@hotmail.com
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ORCID 0000-0002-2086-3087
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 Surgical treatment of ameloblastoma: How does it impact oral health-

related quality of life? A systematic review

Abstract

Purpose: This study aimed to analyze the impact of surgical treatment on the quality of

life of patients diagnosed with ameloblastoma.

Methods: We searched PubMed, Science Direct, LILACS, EMBASE, and Web of

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Science, up to February 2021, with no time restriction. We considered only studies

published in English that evaluated patients diagnosed with ameloblastoma who

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underwent conservative or radical surgical treatments using a quality of life (QOL)
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instrument.
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Results: Of the 2155 studies identified, ten were included in our sample. Only studies

that analyzed QOL of radical surgical treatment were included. No studies that analyzed
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QOL after conservative surgical treatment were found. Across all studies, 283 patients
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(122 females and 161 males; mean age: 28.13 years) were surgically treated for
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ameloblastoma. A total of 69 complications were reported, with the most frequent being

infection in both the donor and recipient site (18 cases) and graft loss (eight cases).

Conclusion: Surgical treatment of ameloblastoma was effective in providing reasonable

health-related QOL, as most of the assessed dimensions were found to improve.

Keywords: Ameloblastoma; Quality of Life; Surgery, Oral; Mouth rehabilitation;

Pathology, Surgical
Introduction

Although rare, ameloblastoma is the second most common odontogenic tumor.

Despite being non-cancerous, it has a locally destructive behavior and can lead to

severe aesthetic and functional complications if not treated. Three types of

ameloblastoma with distinct clinical and histological features are recognized: first,

ameloblastoma, in which the tumor is locally invasive, infiltrating the bone marrow and

possibly presenting multicystic lesions; second, unicystic, in which the tumor has an

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intraosseous cystic growth, a characteristic identified clinically and radiographically; and

third, peripheral, presenting similarly to intraosseous ameloblastoma, but further

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affecting the oral mucosa 1.
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Radical or conservative surgical techniques can be used to treat ameloblastoma.
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Radical treatments primarily consist of marginal and segmental resection, ideally

followed by surgical reconstruction 2. The most commonly reported conservative

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surgical procedures in the literature are bone curettage 3–9 and peripheral ostectomy 10–
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12. Few authors use chemical treatment of the surgical site with cryotherapy 7 or
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Carnoy’s solution 5,13.

Numerous systematic reviews regarding the recurrence of ameloblastoma have

been conducted. All studies concluded that radical treatment is the most effective in

preventing recurrence, despite having more significant surgical morbidity. In

conservative treatment, despite higher recurrence rates, surgical morbidity is much

lower 14–18. For this, surgical approaches are chosen based only on recurrence

outcomes.

However, it is questioned whether relapse implies treatment failure. Furthermore,

radical treatment is associated with potential complications, such as difficulty in

reconstructing extensive bone defects, restoring aesthetics, and masticatory function
5,6,9
.

The assessment of quality of life (QOL) is essential to evaluate the patients’

perception of the social impact of oral disorders and their treatments on their wellbeing
19. Besides clinical outcomes of recurrence, we must consider that patient-centered

outcomes are fundamental in current clinical practice. We have found no systematic

reviews that analyze the oral health-related QOL related to each treatment option.

Therefore, this systematic review should provide information, for the first time,

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regarding the assessment of the impact of the oral health-related QOL of patients

surgically treated for ameloblastoma.

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Materials and Methods
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Protocol and registration

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This systematic review protocol was registered at the International prospective

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register of systematic reviews (PROSPERO) as CRD42021240442.

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This study was conducted in accordance with the ethical standards of the

institutional and/or national research committee and with the 1964 Declaration of

Helsinki and its later amendments or comparable ethical standards.

Inclusion criteria

Studies addressing the treatment of ameloblastoma in children and adults were

selected. The inclusion criteria were based on the PICOS (population, intervention,

comparison, outcome, and study design) format. Studies that enrolled patients

diagnosed with ameloblastoma who underwent conservative or radical surgical

treatments were included. The expected outcome was the assessment of the oral
health-related QOL upon surgical treatment of the lesion, evaluated by a validated QOL

instrument. We included all types of studies, except for case reports and studies with

less than ten cases. A validated oral health-related QOL instrument was considered an

instrument capable of assessing the postoperative oral health-related QOL of patients

treated and analyzing the impact of surgical treatment on their lives.

Exclusion criteria

We excluded studies if they were reviews, editorials, letters, personal opinions,

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book chapters, and conference abstracts; experimental in vitro or in vivo studies;

studies that did not describe the postoperative outcome; studies not addressing the

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QOL; and case reports or studies with less than ten cases.
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Study selection

We identified studies through a search in the following electronic databases:

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PubMed, Science Direct, LILACS, EMBASE, and Web of Science, with additional gray
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literature search in Google Scholar. The search strategy is detailed in Appendix S1. No
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time limit was set. Only articles written in English were considered. All searches were

finished by February 28, 2021. We also searched the reference lists of the included

articles for other pertinent studies that might not have appeared in the search. Duplicate

references were removed with a reference manager (Mendeley Desktop, Elsevier, New

York).

Risk of bias within studies

The Joanna Briggs Institute Critical Appraisal Checklist for Case Series 20 was

used to evaluate the quality of the included studies. The scoring was discussed among

reviewers, with the studies categorized as “high” when the study analysis score was
less than 49%, “moderate” when the analysis scored between 50 and 69%, and “low”

when the analysis of the study scored over 70%.

Summary measures

The main objective of this systematic review was to assess the oral health-

related QOL of patients diagnosed with ameloblastoma and treated by a surgical

approach. Any result measurement was considered in this review.

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Results

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In phase one, we found 2,155 articles in the selected databases. After the
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removal of duplicates, 1,355 articles remained. After evaluating the titles and abstracts,
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we excluded 1,265 studies, and 90 articles remained. No articles from the Google

Scholar database were included in the review. A full reading of the articles selected in
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phase one was performed. This methodology led to the exclusion of 80 studies, with ten
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remaining for final analyses. A flowchart of the selection methodology is shown in

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Figure 1.

Study characteristics

A total of ten studies were selected for the review, including 283 patients affected

by ameloblastoma that were surgically treated. The number of cases in each study

ranged from 11 21,22 to 54 23. The studies were conducted in China 24,25, Greece 26, India
23, Nigeria 27, Singapore 28, Taiwan 29, Tanzania 21,30, and Turkey 22. All studies were

written in English. Articles were published between 2006 and 2018. The selected

studies are listed in Table 1.

Evaluation tools

Six instruments that attempted to measure the facial, oral and psychological

dimensions of health-related QOL were used. Five studies 24–27,29 utilized the University

of Washington Head and Neck Cancer Questionnaire (UW-QOL) 31. Two studies 24,29

also utilized the Oral Health Impact Profile (OHIP-14) 19. The data are summarized in

Table 2. Four others 21–23,28,30 utilized a self-proposed questionnaire. The questionnaire

data are summarized in Table 3.

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Evaluation of the risk of bias

All ten studies were submitted to The Joanna Briggs Institute Critical Appraisal

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Checklist for Case Series 20. Six studies
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remaining four studies had a moderate risk of bias 21,23,26,32. Further information about
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the risk of bias assessment is summarized in Table 4.

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Synthesis of the results

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Only studies that analyzed QOL of radical surgical treatment were included
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(n=10). No studies that analyzed QOL of conservative surgical treatment were found.

Across all studies, 283 patients (122 females, 161 males) with a mean age of 28.13

years were surgically treated for ameloblastoma.

The mandible was the most affected site, with 282 cases, while the maxilla was

affected in one case.

The most prevalent subtype was ameloblastoma (solid/multicystic), with 164

cases. The unicystic subtype accounted for 46 cases. No cases of peripheral

ameloblastoma were reported. Ameloblastoma subtype was not reported in three

studies 21,27,30. Only one study 22 described its histological features in full: five follicular,

four plexiform, one acanthamatous, and one granular cell.

 Follow-up ranged from six months 27,30 to 12 years 29. Follow-up was not reported

in one study 23.

Regarding the surgical procedures performed, most studies 22–26,28,29 used

segmental mandibulectomy and reconstruction with free flap, followed by segmental

mandibulectomy and reconstruction with iliac crest 21,27,30 and segmental

mandibulectomy and reconstruction with a plate 27. The only case of maxillary

ameloblastoma was rehabilitated with an obturator prosthesis 27.

From all of the included studies, 69 complications were reported, with the most

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frequent being infection in both the donor and recipient site (18 cases) and graft loss

(eight cases). A detailed analysis of the complications described is below.

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Simon et al. 21 reported infection (one case), fracture of the cortical scaffolds (two
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cases), graft loss (one case), plate traumatizing oral tissues (three cases), and loss of
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particulate bone chips (two cases). Vayvada et al. 22 reported postoperative hematoma

at the donor site (two cases) and wound infection at the donor site (one case). Simon et
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al. 30 reported infection (two cases), submandibular fistula (two cases), necrotic bone
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(two cases), plate exposure (one case), and graft loss (one case). Zhu et al. 24 reported
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complications associated with wound healing at the donor site (two cases) and

instability of the ankle that impaired physical activity (two cases). Ooi et al. 28 reported

infection (five cases), hematoma (one case), and flap failure (two cases). Lawal et al. 27

reported fractured plates and loosened screws (two cases). Goil et al. 23 reported

surgical site infection (six cases), fracture of the mini-plate (one case), graft loss at the

donor site (three cases), flap failure (one case), split skin graft for the closure of the

donor site (12 cases), venous congestion (one case), and donor site seroma (two

cases). Pappalardo et al. 29 reported partial necrosis involving the skin paddle (two

cases), hematoma at the donor site (one case), infection (two cases), need for

orthognathic surgery to correct malocclusion (one case), and secondary debulking

procedures of the flaps to improve facial symmetry (three cases). Two studies 25,26

reported no complications.

Regarding the oral health-related QOL, five studies used the UW-QOL 31, which

evaluated: pain, appearance, activity, recreation, swallowing, chewing, speech,

shoulder, taste, saliva, mood, and anxiety. All patients had at least six months of

postoperative follow-up. Scores ranged from zero (worst) to 100 (best).

Lawal et al. 27, Zhu et al. 24, Li et al. 25, and Pappalardo et al. 29 reported the

following scores: pain, 97.5, 76.4, 82.21, and 89.6; appearance, 88.33, 74.6, 78.12, and

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75; activity, 99.17, 64.1, 69.48, and 77.1; recreation, 99.17, 65.6, 68.21, and 81.3;

swallowing, 100, 79.2, 77.32, and 86.7; chewing, 68.22, 32.4, 28.48, and 62.5; speech,

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94.43, 68.8, 71.26, and 82.5; shoulder, 100, 81.1, 80.29, and 90; taste, 100, 80.5,
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71.23, and 85; saliva, 97.77, 75, 60.02, and 84.2; mood, 95, 67.1, 67.09, and 79.2; and
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anxiety, 98.89, 65.2, 55.76, and 72.5, respectively.

Gravvanis et al. 26 reported an appearance score of 90. They evaluated speech,

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chewing, and swallowing with a different scale to the studies mentioned above
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(Functional Intraoral Glasgow Scale), reporting a score of 13.7 ± 0.45 (scale ranged
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from zero = worst to 15 = best).

Two studies used the OHIP-14 19, which evaluated these outcomes: functional

limitation, physical pain, psychological discomfort, physical disability, psychological

disability, social disability, and handicap. All patients had at least six months of

postoperative follow-up. Scores ranged from zero (best) to 100 (worst).

Zhu et al. 24 and Pappalardo et al. 29 reported these scores: functional limitation,

52.1 and 28.1; physical pain, 54.2 and 31.3; psychological discomfort, 46.3 and 37.5;

physical disability, 71.1 and 38.5; psychological disability, 48.9 and 30.2; social

disability, 40.8 and 26; and handicap, 34.3 and 21.9, respectively.
 Simon et al. 21,30 used a self-proposed questionnaire, which evaluated these

outcomes: pain, drooling, eating liquids, eating solids, speech, appearance, family

relation, social/work relation, stress/anxiety, and financial problem. Scores ranged from

zero (best) to four (worst).

Simon et al. 21 and Simon et al. 30 reported these scores: pain, 1.2 and 1.1;

drooling, 1, 1; eating liquids, 1 and 1; eating solids, 3 and 2; speech, 2.2 and 1.6;

appearance, 2.5 and 1.9; family relation, 1 and 1; social/work relation, 1.3 and 1;

stress/anxiety, 1.5 and 1.4; and financial problems, 1.9 and 1.1, respectively.

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Goil et al. 23 used a self-proposed questionnaire, which evaluated these

outcomes: resolution of symptoms, chewing, speech, facial symmetry, donor site

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appearance, walking, and improvement in social activity. Scores ranged from satisfied,
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acceptable, and not satisfied, with the following scores: the resolution of symptoms,
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95.4% satisfied; chewing, 84% satisfied; speech, 100% satisfied; facial symmetry,

90.8% satisfied; donor site appearance, 77.2% satisfied; walking, 97.7% satisfied, and
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improvement in social activity, 100% satisfied.

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Ooi et al. 28 used a self-proposed questionnaire, which evaluated these

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outcomes: diet, oral incontinence, speech, facial appearance, recipient site pain,

walking, donor site appearance, and donor site pain. The scores varied for each

question. The authors reported the following scores: diet, 88% normal; oral

incontinence, 100% normal; speech, 100% easily understood; facial appearance, 54%

symmetrical; recipient site pain, 100% none; walking, 92% normal; donor site

appearance, 92% satisfactory; and donor site pain, 92% none.

Vayvada et al. 22,28 used a self-proposed questionnaire, which evaluated these

outcomes: diet, oral incontinence, speech, social activity, facial appearance (patient),

and facial appearance (surgeon). The scores varied for each question. The authors

reported these scores: diet, 100% normal; oral incontinence, 100% normal; speech,
100% easily understood; social activity, 100% normal; facial appearance (patient), 82%

excellent/good; and facial appearance (surgeon), 100% excellent/good.

Despite the heterogeneity among the questionnaires used - as six questionnaires

were used across the included studies - at least five of them evaluated repercussions

on speech, with most scores evidencing normal function or minor complications;

appearance, with most scores reporting symmetry, or an acceptable level of asymmetry;

and chewing/diet, which had the worst scores among the items analyzed (Tables 2 and

3).

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The oral rehabilitation of patients who underwent surgery was performed in six

studies 22–24,28–30, with cohorts ranging from zero 27 to 22 patients 29. From the 283

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patients included, only 73 (25.79%) underwent oral rehabilitation. The studies with the
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best postoperative rehabilitation rates for patients were those of Pappalardo et al. 29
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with 64.7% and Ooi et al. 28 with 60%, with a chewing/diet score of 86.4 and 88,

respectively. In the studies in which no patients were rehabilitated, the average

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chewing/diet score was 62.22 in Lawal et al. 27 and 28.48 in Li et al. 25.
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Pain was evaluated in four questionnaires and presented favorable results, with
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most scores showing little or no pain across the studies 24,26,27,29.

Discussion

Summary of evidence

In this systematic review, only the radical surgical technique was used across all

of the ten included studies. Distinct surgical approaches were employed across the

studies, but discussing the techniques is beyond the scope of this study. We could not

find studies on conservative surgical techniques.

 Regarding the incidence and profile of ameloblastoma, a recent systematic

review 33 found that the mean age of diagnosis is 34 years, with a peak age incidence in

the third decade of life. The solid/multicystic subtype is the most common, with male

predominance (53%) and the mandible as the preferred site. A similar profile was

verified in the present study, with data analysis revealing that the mean age of diagnosis

was 28.13 years, with male predominance (56.9%). The mandible was affected in 282

out of 283 patients.

Regarding recurrence, across the 283 included patients treated for

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ameloblastoma, only two recurrences occurred (0,7%), reflecting the findings of many

systematic reviews 15–18, that radical treatment reduces recurrence rates compared to

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the conservative approaches.
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Regarding classification, from all included cases, the solid/multicystic subtype
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accounted for 164 cases (57%), and the unicystic subtype accounted for 46 cases

(16%). Three studies did not report the ameloblastoma subtype 21,27,30. The number of
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unicystic cases treated by radical surgery is of interest, as recurrence rates range from
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3% (radical) to 21% (conservative) 17. The solid/multicystic subtype has recurrence

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rates ranging from 8% (radical) and 41% (conservative) 17.

The assessment of the health-related QOL through a patient-completed

questionnaire is essential. Health-related QOL seeks to understand the effects of the

disease on the physical, mental, and social aspects, analyzing the repercussions of

therapeutic choices on the patients’ lives. Researchers developed multiple health-

related QOL assessment tools to enable health professionals to understand subjective

health measures. 34 In this study, surgical treatment of ameloblastoma provided

reasonable health-related QOL, as most health dimensions improved, except for

occasionally the chewing/diet scores.

 The mandible and surrounding tissues are essential for chewing, swallowing,

phonation, and facial appearance. Therefore, the adequate reconstruction of complex

mandibular defects is critical for the success of the surgical treatment and enabling the

patient’s oral rehabilitation, further enhancing the oral-related QOL. 28 The assessment

of chewing/diet had the worst scores, although in most studies, patients were not

rehabilitated following surgical resection. Considering that all studies used radical

surgical treatments, which may cause facial scars/asymmetries and donor site

morbidity, it is a significant issue. Only 73 of the patients (25.79%) underwent oral

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rehabilitation in this study.

For oral and maxillofacial surgeons, in addition to decreasing recurrence rates,

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the complete rehabilitation of patients after the treatment of ameloblastoma should be a
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primary objective, through the restoration of functionality lost after bone resection,
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allowing to improve chewing, swallowing, and phonation and maintain symmetry of the

facial aspect.
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Limitations
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Methodological limitations occurred in this systematic review, mainly due to the

heterogeneity of the samples, different questionnaires being used in each study, and

the absence of studies on the conservative approach.

Conclusions

Surgical treatment of ameloblastoma was effective in providing reasonable

health-related QOL, as most of the assessed dimensions were found to improve.

Conflict of interest: The authors state that they have no conflict of interest.
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Oral Maxillofac. Surg. 35, 421–426 (2006).

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22.
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Vayvada, H., Mola, F., Menderes, A. & Yilmaz, M. Surgical management of
re
ameloblastoma in the mandible: Segmental mandibulectomy and immediate
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reconstruction with free fibula or deep circumflex iliac artery flap (evaluation of the

long-term esthetic and functional results). J. ORAL Maxillofac. Surg. 64, 1532–
na

1539 (2006).
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23. Goil, P., Patil, A. N., Malhotra, K. & Chaudhary, G. Microvascular reconstruction
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with free fibula osteocutaneous flap in mandibular ameloblastomas-an institutional

experience. Eur. J. Plast. Surg. 41, 15–20 (2018).

24. Zhu, J., Yang, Y. & Li, W. Assessment of quality of life and sociocultural aspects

in patients with ameloblastoma after immediate mandibular reconstruction with a

fibular free flap. Br. J. Oral Maxillofac. Surg. 52, 163–167 (2013).

25. Li, X., Zhu, K., Liu, F. & Li, H. Assessment of quality of life in giant ameloblastoma

adolescent patients who have had mandible defects reconstructed with a free

fibula flap. World J. Surg. Oncol. 12, 201 (2014).

26. Gravvanis, A., Koumoullis, H. D., Anterriotis, D., Tsoutsos, D. & Katsikeris, N.

Recurrent giant mandibular ameloblastoma in young adults. Head Neck 38 Suppl

 1, E1947-54 (2016).

27. Lawal, H. et al. Quality of life of patients surgically treated for ameloblastoma.

Niger. Med. J. 57, 91 (2016).

28. Ooi, A., Feng, J., Tan, H. K. & Ong, Y. S. Primary treatment of mandibular

ameloblastoma with segmental resection and free fibula reconstruction: achieving

satisfactory outcomes with low implant-prosthetic rehabilitation uptake. J. Plast.

Reconstr. Aesthet. Surg. 67, 498–505 (2014).

29. Pappalardo, M. et al. Long-term outcome of patients with or without

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osseointegrated implants after resection of mandibular ameloblastoma and

reconstruction with vascularized bone graft: Functional assessment and quality of

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life. J. Plast. Reconstr. Aesthet. Surg. 71, 1076–1085 (2018).
re
30. Simon, E. N. M., Merkx, M. A. W., Kalyanyama, B. M., Shubi, F. M. & Stoelinga,
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P. J. W. Immediate reconstruction of the mandible after resection for aggressive

odontogenic tumours: a cohort study. Int. J. Oral Maxillofac. Surg. 42, 106–112
na

(2013).
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31. Rogers, S. N. et al. The addition of mood and anxiety domains to the University of
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Washington quality of life scale. Head Neck 24, 521–529 (2002).

32. Aishwarya, A. S. & Gurunathan, D. Stress level in dental students performing

pedodontic procedure. J. Adv. Pharm. Educ. Res. 7, 34–38 (2017).

33. Hendra, F. N. et al. Global incidence and profile of ameloblastoma: A systematic

review and meta-analysis. Oral Dis. 26, 12–21 (2020).

34. Ethgen, O., Bruyerè, O., Richy, F., Dardennes, C. & Reginster, J. Y. Health-

Related Quality of Life in Total Hip and Total Knee Arthroplasty: A Qualitative and

Systematic Review of the Literature. J. Bone Jt. Surg. - Ser. A 86, 963–974

(2004).
Figure legends

Figure 1. Flow diagram of the literature search and selection criteria adapted from

PRISMA.

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Appendix S1

Search strategy

Search: ameloblastoma AND treatment NOT case report

(("ameloblastoma"[MeSH Terms] OR "ameloblastoma"[All Fields] OR "ameloblastomas"[All
Fields]) AND ("therapeutics"[MeSH Terms] OR "therapeutics"[All Fields] OR "treatments"[All
Fields] OR "therapy"[MeSH Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR
"treatment s"[All Fields])) NOT ("case reports"[Publication Type] OR "case report"[All Fields])
Translations
ameloblastoma: "ameloblastoma"[MeSH Terms] OR "ameloblastoma"[All Fields] OR

f
"ameloblastomas"[All Fields]

oo
treatment: "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields] OR "treatments"[All
Fields] OR "therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR

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"treatment's"[All Fields]
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case report: "case reports"[Publication Type] .or. "case report"[All Fields]
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Excluded studies with reasons

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Excluded studies Reason

A modified surgical approach for the treatment of mandibular unicystic Did not assess the
ur

ameloblastoma in young patients quality of life

A Protocol for Resection and Immediate Reconstruction of Pediatric Did not assess the
Mandibles Using Microvascular Free Fibula Flaps quality of life
Jo

A review of 156 odontogenic tumours in Calabar, Nigeria Did not assess the
quality of life
A treatment algorithm for managing giant mandibular ameloblastoma: 5- Did not assess the
year experiences in a Paris university hospital quality of life
A two-year audit of non-vascularized iliac crest bone graft for mandibular Did not assess the
reconstruction: technique, experience and challenges quality of life
Ameloblastoma demographic, clinical and treatment study - analysis of 40 Did not assess the
cases quality of life
Ameloblastoma in children The Zimbabwean experience Did not assess the
quality of life
Ameloblastoma in Young Jordanians: A Review of the Clinicopathologic Did not assess the
Features and Treatment of 10 Cases quality of life
Ameloblastoma of the jaws: a 12 year review of the McGill experience Study not available
Ameloblastoma of the jaws: a survey of 109 Nigerian patients. Study not available
Ameloblastoma resection with immediate rib reconstruction: addressing Did not assess the
the problem of mandibular angle and central bone bulk quality of life
Ameloblastoma The Zimbabwean experience over 10 years Did not assess the
quality of life
Ameloblastoma Treatment: Clinical Experience Study not available
Ameloblastoma Treatment: Clinical Experience Did not assess the
quality of life
 Ameloblastoma: 25 Year Experience at a Single Institution Did not assess the
quality of life
Ameloblastoma: A retrospective analysis of 31 cases Did not assess the
quality of life
Ameloblastoma: a retrospective single institute study of 34 subjects. Study not available
Ameloblastoma: A Surgeon’s Dilemma Did not assess the
quality of life
Ameloblastoma: clinical features and management of 21 cases. Study not available
Ameloblastoma: clinical features and management of 315 cases from Did not assess the
Kaduna, Nigeria quality of life
Ameloblastoma: demographic data and treatment outcomes from Did not assess the
Melbourne, Australia quality of life
Ameloblastoma: Management and Outcome Did not assess the
quality of life
Ameloblastomas of the Mandible and Maxilla Did not assess the
quality of life
Ameloblastomes des machoires. Analyse retrospective de 1994 a 2007 Not available in

f
English

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An anatomical classification of maxillary ameloblastoma as an aid to Did not assess the
surgical treatment quality of life
An Audit of Mandibular defect Reconstruction Methods in a Nigerian Did not assess the

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Tertiary Hospital. quality of life

ameloblastomas
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Argument for the conservative management of mandibular

Benign paediatric mandibular tumours: Experience in reconstruction using

Did not assess the
quality of life
Did not assess the
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vascularised fibula quality of life
Clinical and pathological analysis of jaw ameloblastomas in 890 patients Not available in
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English
Clinical research of resection of mandibular benign tumors and primary Not available in
reconstruction with autogenous bone graft via an intraoral approach English
Clinicopathological study and treatment outcomes of 121 cases of Study not available
na

ameloblastomas.
Clinicostatistical study of ameloblastoma treatment Did not assess the
quality of life
ur

Comparison of long-term results between different approaches to Did not assess the
ameloblastoma quality of life
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Conservative Management of Unicystic Ameloblastoma in Young Patients: Did not assess the
A Prospective Single-Center Trial and Review of Literature quality of life
Conservative treatment of large mandibular radiolucent benign lesions: a Conference abstract
preliminary report of enucleation and curettage with radiofrequency
ablation
Controversies in ameloblastoma management: evaluation of decision Did not assess the
making, based on a retrospective analysis quality of life
Effect of preservation of the inferior and posterior borders on recurrence Did not assess the
of ameloblastomas of the mandible quality of life
Enucleation combined with peripheral ostectomy: Its role in the Did not assess the
management of large cystic ameloblastomas of the mandible quality of life
Evaluation of Functional and Esthetic Outcome of Patients After Multiple pathologies
Reconstruction with Mandibular Reconstruction Plates Preceded by were included, other
Resection of Benign Odontogenic Neoplasms of Mandible: A Cohort Study than ameloblastoma
Free Fibula Flap Mandible Reconstruction in Benign Mandibular Lesions Did not assess the
quality of life
Free nonvascularized bone graft evolution after mandibular resections: 45 Study not available
cases report
Functional Outcomes of Virtually Planned Free Fibula Flap Reconstruction Did not assess the
of the Mandible quality of life
Gross surgical features and treatment outcome of ameloblastoma at a Study not available
Nigerian tertiary hospital.
Health-Related Quality of life of Patients Surgically Treated for benign Oral Multiple pathologies
 and Maxillofacial Tumours and Tumour-like lesions at Muhimbili National were included, other
Hospital, Tanzania than ameloblastoma
Iliac Crest Flap for Mandibular Reconstruction After Advanced Stage Did not assess the
Mandibular Ameloblastoma Resection quality of life
Immediate mandibular reconstruction in ameloblastoma (an intra osseous Study not available
neoplasm)
Implant restoration on folded fibular graft for the repair of mandibular Study not available
defect
Is Immediate Reconstruction of the Mandible With Nonvascularized Bone Did not assess the
Graft Following Resection of Benign Pathology a Viable Treatment Option? quality of life
Liquid Nitrogen Cryosurgery and Immediate Bone Grafting in the Did not assess the
Management of Aggressive Primary Jaw Lesions quality of life
Long-term outcomes associated with short-term surgical missions treating Multiple pathologies
complex head and neck disfigurement in Ethiopia: A retrospective cohort were included, other
study than ameloblastoma
Management of locally aggressive mandibular tumours using a gas Did not assess the
combination cryosurgery quality of life
Management of mandibular ameloblastoma: the clinical basis for a Did not assess the

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treatment algorithm. quality of life

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Management of primary ameloblastoma of the jaw: a 15 years’ experience Study not available
Management of solid ameloblastoma of the jaws with liquid nitrogen spray Did not assess the
cryosurgery quality of life

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Mandibular ameloblastoma in Singapora - A 10-year review Conference abstract
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Mandibular Ameloblastoma: Analysis of Surgical Treatment Carried Out in
60 Patients Between 1977 and 1998
Did not assess the
quality of life
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Mandibular reconstruction in benign tumors of the mandible Study not available
Mandibular Resection and Reconstruction in the Management of Extensive Did not assess the
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Ameloblastoma quality of life

Non-vascularised iliac crest bone graft for immediate reconstruction of Did not assess the
lateral mandibular defect quality of life
na

Quality of Life of Patients With Segmental Mandibular Resection and Number of cases < 10
Immediate Reconstruction With Plates
Repair of the Mandibular Nerve by Autogenous Grafting after Partial Did not assess the
ur

Resection of the Mandible quality of life

Retrospective analysis of 30 cases of mandibular ameloblastoma operated Study not available
in the Ivory coast from 1992 to 2000
Jo

Retrospective evaluation on the surgical treatment of jaw bones Did not assess the
ameloblastic lesions. Experience with 20 clinical cases quality of life
Retrospective study of ameloblastoma: the possibility of conservative Did not assess the
treatment quality of life
Segmental Mandibulectomy and Immediate Free Fibula Did not assess the
Osteoseptocutaneous Flap Reconstruction with Endosteal Implants: An quality of life
Ideal Treatment Method for Mandibular Ameloblastoma
Surgical challenges in the treatment of advanced cases of ameloblastoma Did not assess the
in the developing world: The authors’ experience quality of life
Surgical management of ameloblastoma in children Did not assess the
quality of life
Surgical management of ameloblastoma: Conservative or radical approach Did not assess the
quality of life
Surgical treatment of recurring ameloblastoma, are there options? Did not assess the
quality of life
Ten-year Evolution Utilizing Computer-Assisted Reconstruction for Giant Did not assess the
Ameloblastoma quality of life
The Epidemiology, treatment, and complication of ameloblastoma in East- Did not assess the
Indonesia: 6 years retrospective study quality of life
The maxillary ameloblastoma: an analysis of 24 cases. Study not available
The significance of surgical therapy of symphyseal location of Study not available
ameloblastoma of the mandible.
 The Use of Liquid Nitrogen Cryotherapy in the Management of Locally Did not assess the
Aggressive Bone Lesions quality of life
Treatment of recurrent mandibular ameloblastoma Did not assess the
quality of life
Trends in Pediatric Ameloblastoma and its Management: A 15 year Indian Did not assess the
Experience quality of life
Use of gas combination cryosurgery for treating ameloblastomas of the Did not assess the
jaw quality of life
Utility Outcome Measures for the Treatment of Ameloblastomas during No cases reported
Childhood
Wide Excision with Immediate Reconstruction of the Mandible Using Free Did not assess the
Fibular Flap in Ameloblastoma of the Mandible—A Need of Time: Our quality of life
Experience of 37 Cases
Wide Surgical Excision with Split Rib Graft Reconstruction of Mandible for Did not assess the
Ameloblastoma; Our 10 Year Experience quality of life

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Table 1. Description of articles features (n = 10)

Y Ameloblast Recur Oral

Cou Age Tumor Follow-
Author ea Gender oma Surgical procedure performed rence Complications rehabilit
ntry (mean) location up
r Subtype s ation
Segmental resection and bone
graft with iliac crest + irradiated Infection (1 case); fractures of the
14-46 cortical rim + Tissuecol (CaCl cortical scaffolds (2 cases); graft loss (1
Simon et 20 Tanz 5 females, 11 12-24 Not
years Not reported and thrombin) (5 cases) 1 case); Plate traumatizing oral tissues (3
al. 21 06 ania 6 males mandible months reported
(27) segmental resection and bone cases); Loss of particulate bone chips (2
graft with iliac crest + Tissuecol cases)

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(CaCl and thrombin) (6 cases)

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Segmental resection and
18-38 17-38 Postoperative hematoma at the donor

r
Vayvada 20 Turk 3 female, 4 multicystic, 11 immediate reconstruction with 3
years 0 months site (2); wound infection at the donor site

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et al. 22 06 ey 8 male 7 unicystic mandible free deep circumflex iliac artery (27,27%)
(25,4) (29.3) (1)
flap (6) and fibular flap (5)

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Infection (2 cases); submandibular fistula
21 12-66 Segmental resection and bone 6-84
Simon et 20 Tanz 32 (2 cases); necrotic bone (2 cases); plate 12
females, years Not reported graft with iliac crest + Tissuecol 1 months
al. 30 12 ania mandible exposure (1 case); and graft loss (1 (37.5%)
11 males (27,7) (CaCl and thrombin) (27.9)

na
case)

Zhu et al. 20 Chin 9 female,

26-58
25 solid, 8
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33
Segmental mandibulectomy and Not
14-60
Complication associated with wound
healing at the donor site (2); instability of 5
Jo
24 years reconstruction with free fibular report
13 a 24 male unicystic mandible months the ankle that impaired physical activity (15,15%)
(43) flap ed
(2)

10-24 26 Segmental mandibulectomy and

20 Chin 12 female, 35 12-32
Li et al. 25 years multicystic, 9 reconstruction with free fibular 0 None 0
14 a 23 male mandible months
(17) unicystic flap

Sing 12-59 24 Segmental mandibulectomy and 12-128

Ooi et al. 20 16 female, 30 Infection (5 cases); hematoma (1 case);
28 apor years multicystic, 6 reconstruction with free fibular 0 months 18 (60%)
14 14 male mandible flap failure (2 cases)
e (27,3) unicystic flap (59)
 20-30 Segmental mandibulectomy and
Gravvani 20 Gree 6 female, 13 13 10-34 Not
years reconstruction with free fibular 0 None
s et al. 26 16 ce 7 male multicystic mandible months reported
(26) flap

Jaw resection and reconstruction

14-47 29 Not
Lawal et 20 Nige 12 female, with plate (13) and Fractured plates and loosen screws (2
years Not reported mandible; report 6 months 0
al. 27 16 ria 18 male nonvascularized iliac crest bone cases)
(27,3) 1 maxilla ed
graft (12)

Surgical site infection (6 cases); fracture

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of mini-plate (1 case); graft loss at the

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8-40 48 Segmental mandibulectomy and Not
Goil et al. 20 25 female, 54 Not donor site (3 cases); flap failure (1 case);
23 India years multicystic, 6 reconstruction with free fibular report 13 (24%)
18 29 male mandible reported split skin graft for the closure of the
(27,9) unicystic flap ed
donor site (12 cases); venous congestion

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(1 case); donor-site seroma (2 cases)
Partial necrosis involving the skin paddle

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(2); hematoma at the donor site (1),
Pappalar 13 12-68 24 solid Segmental mandibulectomy and 2-12
20 Taiw 34 infection (2); orthognathic surgery to 22
do et al. females, years multicystic, reconstruction with free fibular 0 years

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29 18 an mandible correct malocclusion (1); secondary (64,7%)
21 males (33,2) 10 unicystic flap (89,1)
debulking procedures of their flaps to
improve facial symmetry (3)

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Table 2 – Health-related quality of life measured with UW-QOL and OHIP-14 in patients treated for ameloblastoma.

Lawal et al 27 Zhu et al 24 Li et al 25 Pappalardo et al 29 Gravvanis et al 26

Immediate Secondary
Preoperative 7 days 3 months 6 months Oral rehabilitation No oral rehabilitation
reconstruction reconstruction

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Mean Mean Mean Mean Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD

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Pain 89,17 70 91,67 97,5 76,4 6,5 82,21 5,78 87,5 16,8 89,6 12,9 - - - -

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Appearance 46,67 65 81,67 88,33 74,6 9,6 78,12 11,56 79,6 19,9 75 18,5 90 9,8 66 10

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na
Activity 89,33 75,83 94,17 99,17 64,1 8,3 69,48 7,56 88,6 12,7 77,1 19,8 - - - -

Recreation 61,67 73,33 91,67

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99,17 65,6 8,7 68,21 10,59 89,8 12,6 81,3 21,7 - - - -
UW-QOL*31

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Swallowing 100 92,21 98,89 100 79,2 7,2 77,32 6,77 90,5 14,3 86,7 22,3 - - - -

Chewing 78,33 36,67 60 68,22 32,4 1,8 28,48 3,18 86,4 22,8 62,5 29,2 - - - -

Speech 98,89 77,74 89,98 94,43 68,8 9,9 71,26 12,57 89,1 14,8 82,5 15,5 - - - -

Shoulder 100 100 100 100 81,1 5,5 80,29 9,01 91,8 13,7 90 14,8 - - - -
 Taste 100 92,22 100 100 80,5 5,5 71,23 8,76 89,1 14,8 85 15,7 - - - -

Saliva 96,66 94,43 97,77 97,77 75 9,7 60,02 7,62 90,5 14,3 84,2 22,3 - - - -

Mood 58,33 81,67 91,67 95 67,1 1,2 67,09 1,15 86,4 15,3 79,2 21,5 - - - -

Anxiety 65,53 96,66 98,89 98,89 65,2 8,6 55,76 8,23 87,7 15,1 72,5 27,7 - - - -

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* Best score 100, worst score 0

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Functional limitation - - - - 52,1 1,7 - - 23,2 20,2 28,1 23,7 - - - -

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Physical pain - - - - 54,2 1,9 - - 22,6 18,2 31,3 24,7 - - - -

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Psychological discomfort - - -

ur- 46,3 1,2 - - 26,1 21,5 37,5 23,3 - - - -

Jo
OHIP-14** 19

Physical disability - - - - 71,1 9,5 - - 22,2 21,7 38,5 23,3 - - - -

Psychological disability - - - - 48,9 2 - - 26,7 20,5 30,2 22,1 - - - -

Social disability - - - - 40,8 1,3 - - 19,3 15,1 26 20,1 - - - -

Handicap - - - - 34,3 1,2 - - 15,3 13,4 21,9 22,5 - - - -

** Score 40 or fewer = good score

Table 3 – Health-related quality of life measured with a self-proposed questionnaire in patients treated for ameloblastoma.

Simon et al 21 Simon et al 30

Partial Partial
Partial
mandibulectomy mandibulectomy
Parcial Successful mandibulectomy
Total mandibulectomy and and
mandibulectomy reconstruction without
reconstruction reconstruction
reconstruction

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with denture without denture

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Problems with: Mean Mean Mean Mean Mean Mean
Pain 1,3 1,3 1 1.1 1 1.2

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Drooling 1 1 1 1 1 1

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Eating liquids 1 1 1 1 1 1
Eating solids 3 3 3 2.6 1.4 2.2

na
Speech 2,9 2,3 1,3 1.9 1.3 1.6
Appearance 4 2,4 1 2.4 1.2 2.1
Family relation 1 1
ur 1 1 1 1
Jo
Social/work relation 1,5 1,5 1 1 1 1
Stress/anxiety 1,9 1,5 1,1 1.9 1 1.2
Financial problem 2,3 2,3 1,1 1.3 1 1
Key 1: not at all; 2: a
little bit; 3: quite a bit; 4:
very much.
Goil et al 23
Satisfied Acceptable Not satisfied
n Percentage n Percentage n Percentage
Resolution of symptoms 42 95,4 1 2,3 1 2,3
Chewing 37 84 5 11,4 2 4,6
Speech 44 100 0 - 0 -
Facial symmetry 40 90,8 3 6,9 1 2,3
Donor site appearance 34 77,2 5 11,4 5 11,4
Walking 43 97,7 5 11,4 0 -
Improvement in social
44 100 0 - 0 -
activity

Ooi et al 28 Vayvada et al 22
n Percentage n Percentage
Normal 23 88 Diet Normal 11 100
Diet
Soft diet 2 8 Soft diet 0 -
Puree 1 4 Normal 11 100

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Normal 26 100 Oral incontinence Slight drooling 0 -

Oral incontinence Slight drooling 0 - Severe drooling 0 -

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Easily

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Severe drooling 0 - 11 100
understood

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Speech Understood with
Easily understood 26 100 0 -
effort

lP
Speech Understood with effort 0 - Unintelligible 0 -
Understood with
0 - Normal 11 100
difficulty

na
Social activity
Symmetrical 14 54 Dimished 0 -

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Asymmetrical
Facial appearance 11 42 Excellent/good 9 82
but acceptable
Jo
Facial appearance
Poor 1 4 Acceptable 2 18
(patient)
Recipient site
None 26 100 Poor 0 -
pain
Normal 24 92 Excellent/good 11 100
Facial appearance
Walking Slightly impaired 2 8 Acceptable 0 -
(surgeon)
Severely impaired 0 - Poor 0 -
Satisfactory 24 92
Donor site
Acceptable 2 8
appearance
Poor 0 -
None 24 92
Donor site pain
On ambulation 2 8
Table 4 - Joanna Briggs Institute Critical Appraisal Checklist for Case Series

Simon et Vayvada et Simon et Zhu Ooi et Li Gravvanis et Lawal et Goil et Pappalardo et

al. 21 al. 22 al. 30 et al. al. 28 et al. al. 26 al. 27 al. 23 al. 29
24 16

Were there clear criteria for inclusion in the case Y Y Y Y Y Y Y Y Y Y

series?
Was the condition measured in a standard, reliable Y Y Y Y Y Y Y Y Y Y
way for all participants included in the case series?
Were valid methods used for identification of the UN Y UN Y Y Y UN Y Y Y
condition for all participants included in the case

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series?
Did the case series have consecutive inclusion of N Y Y Y Y Y Y Y Y Y

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participants?

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Did the case series have complete inclusion of N Y UN Y Y UN UN Y UN UN
participants?

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Was there clear reporting of the demographics of N N N Y N Y N Y N N
the participants in the study?

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Was there clear reporting of clinical information of Y Y Y Y Y Y Y Y Y Y
the participants?

na
Were the outcomes or follow up results of cases Y Y Y N Y N Y Y UN Y
clearly reported?
Was there clear reporting of the presenting NA NA NA NA NA NA NA NA NA NA
site(s)/clinic(s) demographic information?
Was statistical analysis appropriate? Y ur Y Y Y NA Y Y Y Y Y
Jo
Score 50% 80% 60% 80% 70% 70% 60% 90% 60% 70%

Legend: Y: Yes / N: No / UN: Unclear / NA: Not applicable / Score: Y percentage

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