Nelli̇ Yıldırımyan
Nelli Yildirimyan is an Assistant Professor of the Oral and Maxillofacial Surgery department at Istanbul Medipol University, School of Dentistry since 2021. She graduated from Marmara University School of Dentistry with honors in 2015. She pursued her residency in Oral and Maxillofacial Surgery at Akdeniz University between 2016-2020. She received her title as an oral and maxillofacial surgery specialist after defending her thesis on “P16 and CAPRIN-1 expressions in odontogenic keratocysts and dentigerous cysts”. Her main clinical interests are maxillofacial pathologies, traumatology and dentoalveolar surgery. She authored several research articles published by internationally indexed journals and has four chapters in internationally and nationally published reference books.
“The infamous” Unicystic Ameloblastoma – How to manage?
Ameloblastoma is the second most prevalent odontogenic tumor of the jaws following odontoma. It is a slow-growing, benign tumor that contributes to about 1% of all jaw tumors and 9-14% of all odontogenic tumors of epithelial origin. Ameloblastoma has an incidence rate of 0.92 per million-person-years. According to the World Health Organization (WHO) Classification for Odontogenic Lesions, which have been recently updated for the fifth time, ameloblastoma subtypes are determined as unicystic, extraosseous or peripheral, conventional, adenoid and metastasizing.
Unicystic ameloblastoma (UA) refers to cystic lesions that clinically and radiologically show characteristics of an odontogenic cyst but histologically shows an ameloblastomatous epithelium lining part of the cyst cavity. UA usually presents at the second decade of life and is more prone to affect the male population. The posterior body of the mandible and the ramus are the most affected parts of the jaws. Histologically UA has three subtypes which are luminal, intraluminal, and mural.
There is a no consensus on the management of not only UA but also ameloblastoma in general. Luminal and intraluminal subtypes of UA are advised to be treated conservatively but there is a major controversy on the management of the mural type due to the ongoing debate of whether the mural type is in fact a subtype of conventional ameloblastoma or not. This controversy has still not been elucidated even on the 5th edition of WHO Classification and this sub-entity remained to stay under UA. The choice of treatment depends on the type of the UA and its clinical presentation. Management options for UA vary from curettage, enucleation, marsupialization with or without enucleation to resection with a 1-cm margin of healthy-looking bone. Cryotherapy, thermal or chemical cauterization, radiotherapy, and chemotherapy have also been suggested as adjunct treatments.
This speech aims to review unicystic ameloblastoma from diagnosis to treatment in light with case presentations and the recent literature.