Conservative treatment of large mandibular radiolucent benign lesions: a preliminary report of enucleation and curettage with radiofrequency ablation

Background and objective : In spite of being regarded as benign tumors, ameloblastoma and odontogenic keratocyst of the mandible have an aggressive characteristic with a potentially high recurrence rate, and the management challenges all the head and neck surgeons. The authors hypothesized that the heat energy produced by RF electrodes could steadily transfer to the surrounding tissues where it could precipitate apoptosis of ameloblastoma cells thereby destroying the remnants of these tumors. This retrospectively analysis of patients with radiolucent benign lesions of the mandible will introduce a new operative method, which can preserve the function and the shape of the mandible.

Methods : Twenty-four patients with ameloblastoma,odontogenic keratocys or cementifying fibroma in the mandible were treated by enucleation and bone curettage followed by radiofrequency ablation (RFA). The resulting defect was packed with iodoform gauze postoperatively and was changed regularly every 3–4 weeks. The healing process of the bone cavity and complications were evaluated clinically and radiographically.

Results : Of all 24 cases, 10 cases were odontogenic keratocyst and 1 was cementifying fibroma. 11 cases suffered from primary ameloblastoma and 2 were recurrent ameloblastomas. All the patients recovered uneventfully and the contour and the height of treated mandible were satisfying. No severe complications such as bone cavity (i) infection, sequestration,or pathologic fractures were detected. Hypesthesia of the inferior alveolar nerve was the most frequent complication.

Conclusion : Enucleation with bone curettage and RFA may provide a feasible alternative for the treatment of large mandibular radiolucent benign lesions. It may reduce the need for major resection with the resultant creation of mandibular continuity defects and may decrease the local recurrence rate. Our findings suggest that the mechanism of recurrence prevention and the recovery process after RFA should be further investigated.

Key words mandible; benign lesions; radiofrequency ablation; enucleation; iodoform gauze pack

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Jan 20, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Conservative treatment of large mandibular radiolucent benign lesions: a preliminary report of enucleation and curettage with radiofrequency ablation
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