“Dredging Method” - A Conservative Approach for the Treatment of Ameloblastoma
Daisuke Izumiyama,
Tamaki Yamada, Yoichi Ohiro, Kanchu Tei
Oral and Maxillofacial Surgery, Department of Oral Pathobiological Science, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University
Ameloblastoma is an odontogenic tumor with variable clinical characteristics and histological patterns. Most cases are very extensive at the time of treatment because the tumor has painless and shows a slow and expansive growth. Ameloblastoma is a benign tumor, but the recurrence rate is extremely high if it is treated improperly. Therefore, the main treatment is still wide resection. The resection of the mandible is associated with many complications such as deformity, dysfunction, phychological distress and loss of jaw bone support even after reconstruction. We introduce a conservative procedure “Dredging Method”, which eradicates the tumor and restores the normal form and function of the jaw to overcome these disadvantages. “Dredging Method” consists of the four steps; Deflation, Enucleation, repeated Dredging, and Follow up. Deflation is the first step in which the portion of overlying bone and the tumor wall are removed. It is important to release intracystic pressure and make a single bony cavity. Enucleation is the second step in which the whole tumor is removed with the surrounding bone tissue. Dredging is the third step in which the scar tissue covered by bone surface and the surrounding bone tissue are removed. This step is performed repeatedly to accelerate the new bone formation and to eradicate the tumor cell nests in dredged out scar tissues with an interval of two to three months. Follow up is the last step. A continuous and regular follow up is important to identify the recurrence as a small lesion on X-ray before it sets large. Ameloblastoma is known to occur most commonly on the site of the lower molar. If the teeth are involved in Ameloblastoma, the teeth will almost be extracted because the tumor will recur at the surrounding the teeth. However, recently, in our department, we have tried to preserve both the jawbone and the teeth involved in Ameloblastoma by “modified-Dredging Method“. To preserve the teeth is very important for oral function. We are going to make a standard to preserve the teeth in the future.
(336 words)
