ameloblastomas

Ameloblastomas are rare benign odontogenic tumors that arise from the enamel organ or its remnants. They are locally aggressive and tend to invade surrounding jawbone rather than metastasize. Most develop in the mandible, particularly the posterior region, and affect adults in the 20s to 60s.

Clinically they present as a slow-growing, painless jaw swelling. Teeth may become loose or displaced as the tumor enlarges. Larger lesions can cause facial asymmetry and, rarely, paresthesia or speech changes.

Radiographs typically show a radiolucent lesion that is often multicystic with a soap-bubble or honeycomb appearance; unilocular forms occur, especially in unicystic ameloblastoma. CT or CBCT defines extent; MRI assesses soft-tissue involvement.

Histologically, the conventional solid/multicystic type shows islands of odontogenic epithelium with peripheral palisaded, columnar cells and a central stellate-reticulum-like area. Unicystic lesions have a cystic lining that may show ameloblastic features; the desmoplastic variant shows dense stroma with small epithelial strands. Peripheral ameloblastoma arises in gingival mucosa.

Major subtypes include solid/multicystic (conventional), unicystic, desmoplastic, and peripheral ameloblastoma; malignant counterparts (ameloblastoma with malignant transformation and ameloblastic carcinoma) are rare.

Management is primarily surgical. Conventional lesions require wide en bloc resection with margins; conservative approaches (enucleation, curettage) carry higher recurrence, especially for solid/multicystic tumors. Unicystic lesions without infiltrative features may be managed more conservatively; peripheral tumors have excellent prognosis after excision. Radiotherapy is generally avoided for benign ameloblastomas but may be used for unresectable or malignant cases; chemotherapy is not standard.

Recurrence is a major concern and is highest with conservative treatment. Long-term follow-up of at least 5–10 years is recommended due to potential late recurrence.