SA3 - The Hidden Dangers of Decompressing Ameloblastomas: Evaluating Risks, Recurrence and Treatment Outcomes

Abstract: Decompressing conventional ameloblastoma is controversial, with some small studies supporting its utility. We argue that this is an unsafe practice that can potentially harm patients.

A retrospective chart review evaluated the outcomes of treating conventional ameloblastoma with primary decompression. Inclusion criteria comprised all subjects at The University of Illinois Chicago who were diagnosed with conventional ameloblastoma and subsequently treated initially by prolonged decompression tube placement between the years of 2007 to 2024. Subjects were excluded if they were not initially treated with decompression, had incomplete records, or had follow-up less than six months. The primary outcome was failure of the decompression tube. This included patients where the ameloblastoma became larger, grew through the tube, or did not reduce in size. Secondary outcomes were the mean time of decompression, the number of follow-up clinic appointments, years of clinical follow-ups, complications, recurrences, time to recurrence, and final definitive treatment.

A descriptive analysis was performed. The average time of decompression, visits, tube replacements, complications, decompression failure, delay to final treatment, and recurrence were calculated.

21 patients with a diagnosis of conventional ameloblastoma and placement of a decompression tube were found. After applying inclusion/exclusion criteria, 11 subjects with prolonged decompression of conventional ameloblastoma were included for data analysis. Most of the lesions were partially cystic. The average age was 25 years old, with seven male and six female patients.

The primary outcome of decompression failure was n = 10, 91%. 15.3% of patients experienced soft-tissue growth in the tube. The average decompression time was 475.7 days, with an average of 9.1 visits over an average of five and a half years. One patient was lost to follow-up after 70 months of decompression. The number of recurrences was 10 in 4 patients, with one experiencing 5 recurrences. The average time to recurrence was three years, with the longest being 9.5 years. The definitive treatment for one patient was enucleation and curettage, and 9 out of the 11 patients were resected. Out of these 9 patients, decompression made none of their lesions smaller, 5 had a change in size, and 4 had larger resections performed than originally indicated. On average, patients had a delay of 39.9 months to definitive treatment.

In this study, decompression of conventional ameloblastoma was found not to be beneficial for patients, and in many cases harmful, resulting in larger resections of hard and soft tissues, seeding of tumor into soft tissues adjacent to the decompression tube, and most commonly causing long treatment delays. Most patients who underwent decompression still required a definitive resection. Margins of one and a half centimeters are required to properly resect ameloblastoma, including one uninvolved barrier.¹ Soft tissue resection and reconstruction with a soft tissue flap are required in patients with growth through the decompression tube. Literature exists that shows positive decompression results with no recurrence after a 2.5-year follow-up.² Our data suggests that follow-ups of at least 3 years should be performed, with follow-ups of up to 10 years being necessary in some cases.


References:
1. Carlson, E. R., & Marx, R. E. (2006). The ameloblastoma: primary, curative surgical management. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons, 64(3), 484–494. https://doi.org/10.1016/j.joms.2005.11.032
2. Quisiguiña-Salem, C. M., Alonso-Moctezuma, A., Martínez, C. M., Salgado-Chavarría, F., Legorreta-Villegas, I., & Jerez-Robalino, J. (2024). Decompression, an Unusual Treatment Option for Multicystic Ameloblastoma: Concepts and Controversies. Case reports in dentistry, 2024, 7126223. https://doi.org/10.1155/2024/7126223