Unicystic Ameloblastoma: analysis of surgical management and recurrence risk factors

Abstract Unicystic ameloblastoma is a distinct pathological variant with varying evidence published about its behaviour and surgical management. Due to paucity of large studies in the literature with long-term follow-up, the aim of this study was to analyse its surgical management and identify clinico-pathological features associated with recurrences. All histopathologically confirmed lesions diagnosed at two referral centres between 1995 and 2020 were retrospectively analysed. Demographic, clinical, radiological and histopathological features were analysed along with surgical methods and follow-up data. Univariate regression analyses were performed to identify risk factors for recurrence. Sixty-three patients were included in the study with mean age of 26.3 years and a male to female ratio of 1:0.75. The majority of lesions occurred in the posterior mandible (57.1%) and were unilocular (88.9%). Most lesions were managed with enucleation followed by application of Carnoy’s solution (Ferric chloride: 1g; Chloroform: 3mL; Glacial acetic acid: 1 mL; Ethyl alcohol 96%: 6 mL) and burring of the peripheral bone margin which resulted in the lowest recurrences (9.1%) besides resection. Significantly associated clinico-pathological features with recurrences included males, large lesions (>90mm), presence of root resorption, cortical perforation, mural subtype and retention of associated teeth. In conclusion, decision making in the management of unicystic ameloblastoma should be based on the clinico-pathological features and not be solely based on the histopathological subtype. Enucleation followed by application of Carnoy’s solution and burring of the peripheral bone margin was demonstrated to be the least invasive method with an acceptable low recurrence rate.