Ameloblastoma of the mandible: current approaches to classification, diagnosis, surgical treatment and reconstruction

Ameloblastoma is the most clinically significant benign epithelial odontogenic tumour, characterised by locally aggressive growth and a marked tendency to recur; up to eighty percent of these tumours arise in the mandible, predominantly in the molar, angle and ramus regions.

The aim of this review was to systematise current data on the classification, molecular basis, diagnosis, surgical treatment and mandibular reconstruction of ameloblastoma.

The literature was searched in the PubMed, ScienceDirect, eLibrary and CyberLeninka databases using the keywords ameloblastoma, mandible, odontogenic tumours, recurrence and reconstruction; systematic reviews, meta-analyses, original studies, clinical observations and fundamental manuals, mainly from the last two decades, were selected and synthesised qualitatively.

The review addresses the classification of the tumour according to the fifth edition of the World Health Organization classification of head and neck tumours (2022), the molecular and genetic mechanisms of its development (alterations of signalling pathways involving the BRAF and SMO genes), the principles of radiological diagnosis with the leading role of cone-beam computed tomography, the histological variants and special forms (unicystic, desmoplastic, peripheral and metastasising), and the surgical treatment strategy. Data on recurrence rates after conservative and radical interventions are analysed, and the role of adequate resection margins is substantiated. Modern methods of bone and alloplastic reconstruction of the mandible are considered separately, including reconstruction titanium plates, vascularised flaps and custom-made titanium constructions manufactured using digital design and virtual surgical planning. It is concluded that an individualised approach to diagnosis, radical treatment and reconstruction is required.

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