The Treatment of Ameloblastoma Based on Pathologic and

Anatomic Principles
DAVID G. GARDNER, DDS, MSD,* AND ANTONY M. J. PSCAK, BSct

A number of important factors must be considered in planning the treatment of ameloblastoma. It is

essential to distinguish among the three clinical types of ameloblastoma -the intraosseous solid o r multicystic lesion, the well-circumscribed unicystic type, and the rare peripheral (extraosseous) ameloblastoma -because they require different forms of treatment. Unicystic ameloblastomas in which the tumor
extends into the lumen of the cyst o r involves only the cystic lining can be expected to be removed completely by enucleation. This approach, however, is inadequate if the tumor has invaded the periphery of
the fibrous connective tissue wall. Ameloblastomas may invade the intertrabecular spaces of cancellous
bone but do not invade compact bone, although they may erode it. Ameloblastomas in the posterior part
of the maxilla should be treated more extensively than similar lesions in the mandible because of the proximity of the posterior maxilla to vital structures and the difficulty in treating any recurrences. This article
discusses the treatment of ameloblastoma based on these pathologic and anatomic considerations and
includes brief discussions of the role of cautery, cryotherapy, and radiotherapy.
Cancer 46:2514- 2519, 1980.

on ameloblastoma, the principles for treatment of this tumor

are still not well established. There is considerable disagreement between those who advocate so-called radical
surgery and those who prefer a more conservative
approach. There appear to be a number of reasons for
this disagreement: 1) The ameloblastoma is a relatively
rare tumor; consequently, few surgeons have had
extensive experience in its treatment; 2) there are few
well-documented, long-term studies on patients who
have been treated for ameloblastoma; 3) there has been
insufficient recognition of the importance of basing
treatment partly on whether the tumor is a solid or multicystic lesion of the jaws with poorly defined margins,
a well-circumscribed unicystic lesion, or a peripheral
(extraosseous) ameloblastoma; 4) more attention
should be paid to such variables as the location of the
tumor in the jaws and the age of the patient; and finally,
5 ) much of the writing has been imprecise, using terms
such as radical and conservative to describe
treatment. Little effort has been made to define these
terms.
ESPITE T H E E X T E N S I V E LITERATURE

From the Division of Oral Pathology, Department of Pathology,

The University of Western Ontario, London, Canada.
* Professor and Chairman, Division of Oral Pathology.
+ Summer Undergraduate Research Scholar, The Medical
Research Council of Canada.
Address for reprints: D. G. Gardner, DDS, Department of Pathology, The University of Western Ontario, London, Canada N6A 5C1.
Accepted for publication December 31, 1979.

The literature contains many case reports of single or

small numbers of cases that add little to our knowledge
of the subject. However, there are a number of important articles that have attempted to describe a rational
approach to the treatment of ameloblastoma based on
the knowledge available at the time. These include Waldrons Ameloblastoma in Perspective4 and papers
by Kramer, Mehlisch, Dahlin, and Masson,14 and
Sehdev et al. la Robinson and Martinez17 have written
specifically about the unicystic form of ameloblastoma,
while GardnerXhas discussed the peripheral ameloblastoma.
In this paper, we suggest a logical approach to the
treatment of ameloblastoma based upon pathologic and
anatomic principles.

Biologic Behavior

The ameloblastoma is characteristically considered

to be a slowly growing, locally invasive tumor with a
high rate of recurrence if not removed adequately, but
with virtually no tendency to metastasize. Failure to
provide adequate treatment often results in multiple
recurrences, a feature that led to RobinsonI6 aptly
describing the ameloblastoma as being clinically persistent. This reputation for multiple recurrences has
occasionally led to more extensive treatment than has
been justified. Left untreated, or inadequately treated,
ameloblastomas may become very large. Ewing7
describes one as large as a childs head and refers to

0008-543X18011201125 14 $0.80 0 American Cancer Society

2514

No. 1 1

AMELOBLASTOMA Gnrdner and Pqcak

another of 26 years duration which weighed 1.5 kg.

However, ameloblastomas even approaching this size
are seldom seen now in the developed countries. The
ameloblastoma metastasizes only rarely. Small and
Waldron2 found only 21 possible examples in their
series of 1036 ameloblastomas recorded in the literature.
Their review covered the period of 1883 to 1953. In a
subsequent study, covering the period 1953 to 1966,
Carr and Halperin4 found five more proven malignant
ameloblastomas and a further 12 possible cases.
A most important property of the ameloblastoma,
and one that has a direct bearing on its treatment, is
that stressed by Kramer. H e pointed out that, while
ameloblastomas invade the intertrabecular spaces of
cancellous bone without accompanying resorption of
the trabeculae, they do not invade compact bone,
although they may erode it. It follows that ameloblastoma often extends into cancellous bone that appears to
be uninvolved radiographically and during surgery.
Consequently, if the treatment consists of curettage or
enucleation, the tumor tends to be left in the surrounding bone and may subsequently recur. In contrast, the
clinical and radiographic margin of the tumor in the
region of the compact bone of the inferior and posterior
borders of the mandible is probably the true border of
the ameloblastoma, and this bone therefore need not be
removed unless other surgical considerations dictate
that it should be.
The above discussion applies principally to the typical intraosseous solid or multicystic ameloblastoma
with poorly-defined margins. However, there are two
other clinical types of ameloblastoma that behave differently-the
unicystic ameloblastoma and the peripheral ameloblastoma.
Robinson and Martinez have studied the unicystic
ameloblastoma thoroughly. Most of their cases resembled dentigerous cysts, but others resembled residual
or primordial cysts clinically and radiographically. Unicystic ameloblastomas consist of cystic lesions in which
one or more of the following features are present: 1) the
lining epithelium is ameloblastomatous; 2) one or more
nodules of ameloblastoma project into the cystic lumen;
3) ameloblastomatous epithelium of the lining has proliferated into the connective tissue wall of the cyst; and
4) islands of ameloblastoma are present in the connective tissue wall of the cyst. The histologic distinction
between ameloblastoma and hyperplastic proliferation
of epithelium in cystic lesions is sometimes difficult. It
is therefore noteworthy that Robinson and Martinez
used specific histologic criteria similar to those of
Vickers and Gorlin2:3to identify ameloblastoma. Robinson and Martinezli reported that the age of their 20
patients was 10-29years compared with the average age
of 37.5 years reported by Robinson6 for ameloblas-

2515

tomas. Three out of 17 of their unicystic ameloblastomas, all of which were treated by enucleation,
recurred, a considerably lower rate than the 55-90%
quoted in various article^'*,^^.^^ for ameloblastomas
treated by curettage. Two of the patients in Robinson
and Martinezs17 series had very short follow-up
periods, however. There is one further point concerning
unicystic ameloblastomas that has an important bearing
on their likelihood to recur after enucleation. If the
ameloblastomatous epithelium simply lines the cystic
lumen or projects into the lumen, in both cases without
involving the connective tissue wall, the unicystic
ameloblastoma can be expected to be removed completely by enucleation and recurrence is unlikely. On
the other hand, if there is proliferation of the ameloblastoma lining the cystic lumen into the periphery of
the connective tissue wall, or there are islands of ameloblastoma in the wall, then more ameloblastoma may be
present in the cancellous bone surrounding the cystic
lesion and recurrence is possible. This distinction does
not appear to have been clearly stated in the literature,
and as yet, there are no studies to confirm this expected
difference in biologic behavior of the two types of unicystic ameloblastoma.
The term, mural ameloblastoma, has been used for
ameloblastomas in the walls of cystic lesions, but it is
not always clear whether it is used to refer to all four
possible appearances described by Robinson and
Martinez in unicystic ameloblastomas. Moreover,
intraluminal or luminal ameloblastoma has occasionally been used to describe those unicystic ameloblastomas in which the lining epithelium is ameloblastomatous, or in which one or more nodules project into
the cystic lumen, in both cases without involvement of
the connective tissue wall. For simplicity, these terms
will be avoided in this article in favor of unicystic
ameloblastoma.
The third important clinical type of ameloblastoma
is the rare peripheral ameloblastoma. It has been
defined as an odontogenic tumor with the histologic
characteristics of an intraosseous ameloblastoma but
occurring solely in the soft tissues covering the toothbearing parts of the jaws.s The occasional questionable
ameloblastomas that have been reported in other parts
of the oral cavity are excluded by this definition. Basal
cell carcinomas have also occasionally been reported of
the gingiva, but they are indistinguishable histologically
from the basal cell pattern of ameloblastoma. It is therefore reasonable to consider such lesions as peripheral
ameloblastomas. GardnerX has recently studied 2 1
cases of peripheral ameloblastoma, including five which
had been reported previously as basal cell carcinoma of
the gingiva.
The peripheral ameloblastoma appears as an epulis

25 16

CANCER
December 1 1980

measuring up to 2 cm. So far only one case has been

reported as invading bone, but peripheral ameloblastomas may cause a cupping of the underlying bone,
similar to that sometimes seen with peripheral giant
nasolabial cell granulomas and nasoalveolar cysts. They
lack the persistent invasiveness associated with the
intraosseous solid or multicentnc type of ameloblastoma
and do not tend to recur if excised adequately.x
The Value of Histologic Examination in Predicting the
Biologic Behavior of Individual Cases

The pathologists diagnosis of ameloblastoma from a

biopsy is essential before definitive treatment is begun
for intraosseous solid or multicystic ameloblastomas.
Unicystic and peripheral ameloblastomas are usually
removed on the basis of their being cysts and epulides,
respectively, and their true nature only determined
upon subsequent histologic examination. Odontogenic
tumors are rare and exhibit a wide spectrum of histologic appearan-2s. It is therefore important that the
pathologist re1 j . ing the diagnosis be experienced with
these lesions; . isultation with an oral pathologist is
usually advisame. A number of odontogenic tumors,
including the ameloblastic fibroma and adenomatoid
odontogenic tumor, are still confused with ameloblastoma but lack its invasive qualities. Rests of odontogenic epithelium can be mistaken for ameloblastoma,
and salivary gland tumors on occasion cause problems
in differential diagnosis. The detailed histologic features of ameloblastoma and its differential diagnosis are
not within the scope of this paper, but it is obviously
essential that the correct diagnosis be reached.
The true ameloblastoma exhibits a variety of histologic patterns that are important only in that they must
be recognized as ameloblastoma. Recognizing that they
have no value in determining the degree of invasiveness
of individual cases or in predicting the extremely rare
examples that metastasize is essential. These various
histologic patterns include follicular, acanthomatous,
plexiform, granular cell, and basal cell types.
In unicystic ameloblastomas, microscopic examination can be useful beyond simply establishing the
correct diagnosis. The pathologist should also note in
his report which of the two possible situations is present. The ameloblastomatous epithelium may involve
only the cystic lining or have proliferated into the
lumen. Alternatively, it may have involved the connective tissue wall of the cyst. This distinction is important
in predicting the chances of recurrence, because in the
former situation, enucleation would be expected to be
curative, whereas tumor may also be present in the
surrounding cancellous bone in those cases where it has
involved the periphery of the connective tissue wall of
the cyst; recurrence is therefore possible.

Vol. 46

There remains the difficult problem of distinguishing

histologically between apparently hyperplastic proliferation of epithelium in the lining of odontogenic
cysts and unicystic ameloblastoma. Vickers and
GorlinZ3have defined histologic criteria for the early
delineation of ameloblastoma in odontogenic cysts. The
apparently hyperplastic epithelium does not meet these
criteria, but nevertheless unequivocal ameloblastoma
has been found in other parts of a number of these cysts
exhibiting this pattern, and moreover, other cysts,
exhibiting only this pattern, have recurred. Detailed
studies of the biologic behavior of cysts exhibiting
this histologic pattern are needed. In the meantime,
such patients should be examined periodically, as if
they had had a unicystic ameloblastoma removed.
Again in connection with possible unicystic ameloblastomas, some pathologists have used such terms as
ameloblastic change, ameloblastomatous change,
and preameloblastic change when they have not
been convinced that the lesion was in fact an ameloblastoma. These terms have not been clearly defined in the
literature and as a result are confusing. It would be
better to state that histologic changes are present which
are suggestive but not diagnostic of ameloblastoma and
to recommend that the patient be followed closely.
Microscopic examination of peripheral ameloblastomas can be useful in confirming that the lesion is
localized to the soft tissues and does not involve bone.
Treatment
Ameloblastomas are usually treated surgically; this
paper will therefore be concerned primarily with this
modality, with some discussion of the role of cautery
and cryotherapy . These tumors are generally considered to be radioresistant, but radiotherapy has been
used and will be discussed briefly at the end of the
article. As noted previously, ameloblastomas metastasize very infrequently. Consequently, this possibility
should not be a factor in planning their treatment.
The terminology used for various surgical procedures
should be precise, and the extent of the surgical procedure should be described adequately if the effectiveness
of these various methods is to be compared. Unfortunately, this desired precision is often lacking in reports
in the literature. The vagueness of the unqualified
terms, radical and conservative treatment, has
already been mentioned. Other examples of imprecision are the use of curettage and enucleation synonymously, the unqualified use of the term excision, and
the failure to state the amount of apparently uninvolved
bone removed in partial resections.
The following terms are used in this paper: 1. Curettage-surgical scraping of the wall of a cavity within
soft tissue or bone for the removal of its contents. 2.

No. 1 1

AMELOBLASTOMA
*
Gardner and Pecak

Enucleation-removal
of a lesion by shelling it out
intact. 3. Marginal resection (Block resection)- surgical removal of a tumor intact, with a rim of uninvolved
bone.14 In the present context, this procedure usually
implies maintaining the continuity of the inferior or
posterior borders of the mandible. 4. Segmental resection of the mandible or maxilla- surgical removal of a
segment of the mandible or maxillar without maintaining the continuity of the bone. 5. Hemisection
(hemimandibulectomy, hemimaxil1ectomy)-surgical
removal of one side of the mandible or maxilla.
The selection of treatment for an individual ameloblastoma depends to a large extent on its clinical type,
that is whether the tumor is a typical intraosseous solid
or multicystic ameloblastoma with poorly-defined
margins; a unicystic ameloblastoma; or a peripheral
ameloblastoma. Other factors of importance are its location in the jaws and its size, the age of the patient, and
the patient's availability for follow-up examinations.
Intraosseous Solid or Multicystic Amelohlastomas
The location in the jaws is important in the planning
of treatment for these tumors. Approximately 80% of
ameloblastomas occur in the mandiblez0where the solid
or multicystic type invades the intertrabecular spaces
but not cortical bone, although it may erode it.I2 As
mentioned previously, the border of the tumor in cancellous bone generally lies beyond the clinically and
radiographically apparent boundaries; recurrence is
therefore probable if the tumor is removed only to these
apparent boundaries. On the other hand, the apparent
boundary at the cortical plate is probably the true
margin of the ameloblastoma. Large tumors may
eventually break through the cortical plate and involve
the periosteum and adjacent soft tissues.
These principles suggest that the most appropriate
treatment for small solid or multicystic ameloblastomas
of the body of the mandible is marginal resection with
a 1- 1.5 cm border of apparently uninvolved bone. The
inferior cortex of the mandible is preserved, albeit as
a calculated risk. Crawley and Levinj have suggested
preserving the buccal and lingual cortical plates also,
but such a procedure would probably complicate the
operation unduly without any real advantage to the
patient. Regrettably, there appears to be no large series
in the literature dealing with the success rate of treating
ameloblastomas initially by marginal resection. Several
individdal cases have been reported in which there was
no recurrence following this treatrnet~t.'~,'",'~
In addition, a few examples have been reported in which
marginal resection was used to treat tumors that had
recurred after previous treatment. Some of these have
recurred again. l 8 , I 1 )

25 17

Segmental resection should be employed if the cortical plate of the inferior border of the mandible is
markedly thinned or expanded and involvement of the
adjacent soft tissues therefore a possibility. Ameloblastomas can proliferate in soft tissues, and removal of a
border of soft tissue adjacent to such an area is consequently advisable. If the results of three r e p o r t ~ ' ~ . ' ~ , ' ~
are combined, 59 cases of ameloblastoma were treated
initially by segmental resection, of which ten recurred.
Segmental resection also has its place in the treatment
of recurrent lesions when marginal resection is considered to be inadequate. In the same three reports, 37
such cases were treated with two further recurrences.
In general, curettage should not be used in the treatment of ameloblastoma because there is a high risk of
recurrence. The actual rate has varied in different
series. WaldronZ4reported a 55% rate of recurrence in 27
patients, while Shatkin and H o f f m e i ~ t e rand
' ~ Sehdev
et al. l 8 reported 86% and 90% recurrence in 13 and 32
cases, respectively. A surgeon who uses curettage for
ameloblastomas must be fully aware of this high risk of
recurrence and reserve such treatment for patients
whom he can be certain offollowing closely. Moreover,
its use should be confined to small mandibular lesions
in which it will be possible to perform a marginal or
segmental resection later if there is recurrence.10'24
The
ameloblastoma is a slowly growing tumor; consequently, curettage may be appropriate in highly
selected cases, such as the elderly, when it is desired to
spare the patient a more extensive operation. In this
situation, the patient could die of other causes before
any recurrence is manifest. If curettage is used for relatively smaller tumors of the body of the mandible, any
small recurrence is generally limited to a small focal
area that can be subsequently resected. This approach
to treatment has been discussed in detail by Stout,
Lynch, and Lewis."
Cauterization of the cavity after curettage is potentially more effective than curettage alone."' It causes
ischemia and necrosis some distance beyond the
boundaries of the surgical cavity and could destroy
unidentified tumor in the surrounding cancellous
bone.14 There is little supporting evidence in the literature for the success of this treatment. Nevertheless, it
is reasonable to conclude that cautery should be used as
an auxillary treatment whenever curettage is employed
in the treatment of ameloblastoma. It bears emphasizing however, that curettage, and curettage with subsequent cautery , are not reliable forms of treatment for
ameloblastoma and should be avoided if possible.
The same anatomic and pathologic principles that
govern treatment of ameloblastomas of the body of the
mandible apply to ameloblastomas of the ascending
ramus. The posterior border of the ramus is compact

25 18

CANCER
December 1 1980

bone, and consequently, marginal resection of a small

ameloblastoma in the ascending ramus with preservation of the posterior cortical plate appears to be appropriate. Segmental resection would be required for more
extensive lesions. Curettage should be avoided because
of the proximity of this part of the mandible to vital
structures that may become involved if there is recurrence. The technique of segmental resection in this
area of the mandible has been described by Thoma.22
Almost all ameloblastomas of the maxilla occur in the
posterior region where the anatomical relationships
permit the tumor to spread readily into adjacent vital
areas. The maxilla lacks the thick cortical plates that,
in the mandible, tend to confine the tumor.11J4
The thinner walls of the maxilla are readily penetrated
by the ameloblastoma, which can then involve the
maxillary sinus, pterygomaxillary fossa, infratemporal
fossa, and nasal cavity. Further extension can then lead
to intracranial invasion and involvement of the orbit.
Eradication of the tumor becomes difficult once it has
progressed beyond the boundaries of the maxilla.
Because of these anatomical considerations, curettage,
with its high risk of recurrence, should never be used in
the treatment of ameloblastomas of the posterior part
of the maxilla. The treatment of choice is resection of
the tumor with a 1- 1.5 cm margin of apparently normal
bone wherever possible. The size and extent of the
tumor determines the amount of the maxilla that has to
be excised. Again, details of the surgical procedures
involved have been described by Thoma.22Crawley and
Levinj have suggested that treatment of ameloblastomas of the anterior maxilla, because of their relative
distance from vital structures, should be less extensive
than for those in the posterior maxilla. This suggestion
is reasonable, but it should be remembered that ameloblastomas of the anterior maxilla represent less than 2%
of these tumors.9

Unicystic am el oh la stoma^
Those unicystic ameloblastomas in which either the
cystic lining alone is ameloblastomatous, or in which
the tumor has proliferated into the lumen, can be
expected to be cured by enucleation because the fibrous
connective tissue wall of the cyst completely surrounds
the tumor and provides an adequate margin of uninvolved tissue. In most cases, these tumors have already
been enucleated on the basis of their being cysts
clinically, and the histopathologic diagnosis is only
made after this treatment has been performed. N o
further treatment is indicated, but it is important that
the patient receive periodic examination of the
surgical site.

Vol. 46

As has been mentioned previously, the posterior

maxilla represents a particularly dangerous location for
potentially invasive tumor. Therefore, surgeons may
understandably be reluctant to confine their treatment
to enucleation in this site, even when dealing with unicystic ameloblastomas. In such cases, marginal resection should be employed.
Insufficient attention has been paid to separating the
above tumors from those unicystic ameloblastomas in
which the periphery of the connective tissue wall of the
cyst is involved by the tumor and consequently provides no margin between the tumor and the surrounding
bone. This type of unicystic ameloblastoma should be
treated by marginal resection, after the initial enucleation or curettage.
Peripheral Ameloblastomas
Peripheral ameloblastomas are relatively innocuous
lesions that should be excised with a small margin of
normal tissue, and the surgical site re-examined periodically.HThe excision should be down to the periosteum, but it should not generally be necessary to
remove bone or teeth.

Radiotherapy
There appears to be general agreement in the literature that the ameloblastoma is radioresistant and that
consequently radiotherapy should not be used in its
treatment. However, there is very little evidence
reported, especially recently, to substantiate this belief.
In particular, no reports concerning the effect of the
newer higher energy types of radiotherapy on ameloblastomas appear to have been published. There is the
danger of postradiation sarcoma, as reported by Becker
and
and of osteoradionecrosis. For these reasons
alone, radiotherapy should not be employed in the treatment of ameloblastomas except in inoperable tumors.
In view of these potential complications and the general
belief that ameloblastomas are radioresistant, it is unlikely that reports of series of cases treated by radiotherapy will be forthcoming.

Cryotherapy
In recent years, there has been some interest in the
possible use of cryotherapy in the treatment of amelob l a s t ~ m a . ~This
. ~ *subject
~~
has been discussed in detail
by Marciani and his c o - w o r k e r ~ . The
' ~ advantages of
cryotherapy appear to be two. It can devitalize a margin
of apparently normal bone and could therefore be used
after curettage or other limited surgical procedures to
destroy any remnants of tumor in the surrounding bone.

AMELOBLASTOMA
. Gardner and Pecak

No. 1 1

Second, if a marginal or segmented resection were performed, the resected bone could be grossly debrided of
tumor, frozen, and reimplanted as an autogenous graft.
Disadvantages include the increased tendency to fracture of such devitalized bone and its susceptibility to
infection if not adequately covered by soft tissue. Cryotherapy probably should not be used in the posterior
maxilla because of the proximity of this area to vital
structures and the consequent necessity of completely
removing the tumor at the first operation. There is as
yet insufficient information available concerning the
use of cryotherapy in the treatment of ameloblastoma,
but further studies on its effectiveness are warranted.

Summary
Several important factors ought to be considered in
planning the treatment of ameloblastoma:
1. It is essential to distinguish among the three clinical types of ameloblastoma: the intraosseous solid or
multicystic lesion; the well-circumscribed unicystic
type; and the rare peripheral (extraosseous) ameloblastoma because they require different forms of treatment.
2. Unicystic ameloblastomas in which the tumor
extends into the lumen of the cyst or involves only the
cystic lining can be expected to be removed completely
by enucleation, whereas this treatment is inadequate if
the tumor has invaded the outer part of the fibrous
connective tissue wall of the cyst.
3. Ameloblastomas may invade the intertrabecular
spaces of cancellous bone but do not invade compact
bone, although they may erode it. This feature has a
direct bearing on treatment.
4. Ameloblastomas in the posterior part of the maxilla
should be treated more extensively than similar lesions
in the mandible because of the proximity of the
posterior maxilla to vital structures and the difficulty in
treating any recurrences.
The treatment of ameloblastoma based on these
pathologic and anatomic considerations has been discussed.
Addendum
S i n c e t h i s p a p e r w a s a c c e p t e d f o r p u b l i c a t i o n , an a n a l y s i s
of 24 cases of maxillary a m e l o b l a s t o m a h a s been published.z

These authors recommend block resection, short of

. ..a

2519

partial m a x i l l e c t o m y as t h e preferred m e t h o d of successfully e r a d i c a t i n g t h e tumor in this site.

REFERENCES
I . American Society of Oral Surgeons. Oral and Maxillofacial
Surgery Procedural Terminology with Glossary, 1st ed. Chicago:
1975.
2. Becker R , Pert1 A. Zur therapie des ameloblastoms. DtSch Zahn
Mund Kieferheilkd 1967; 49:423-436.
3 . Bradley PF. Modern trends in cryosurgery of bone in the
maxillo-facial region. I n t J Orul Surg 1978; 7:405-415.
4. Carr R F , Halperin V. Malignant ameloblastomas from 1953 to
1966. Review of the literature and report of a case. Orul Surg 1968;
2 6 3 14-522.
5 . Crawley WA, Levin LS. Treatment of the ameloblastoma. A
controversy. Cancer 1978; 42:357-363.
6. Emmings FG, Gage AA, Koepf SW. Combined curettage and
cryotherapy for recurrent ameloblastoma of the mandible: report of
case. J . Orul Surg 1971; 29:41-44.
7. Ewing J . Neoplastic Diseases, 4th ed. Philadelphia and Lohdon:
W. B. Saunders Company, 1940:770-776.
8. Gardner DG. Peripheral ameloblastoma. A study of 21 cases,
including 5 reported a s basal cell carcinoma of the gingiva. Cuncer
1977; 39: 1625- 1633.
9. Goodsell J F , Yamashita D-D, Moody R. Ameloblastoma of the
anterior maxillae. J . Surg Oncol 1977; 9:407-416.
10. Huffman GG, Thatcher J W . Ameloblastoma - the conservative
surgical approach to treatment: report of four cases. J Oral Surg
1974; 32:850-854.
1 I . Khanna S , Khanna N N . Predicting recurrence iri mandibular
and maxillary ameloblastoma. Ear N m e Throcrr J 1978; 57:56-62.
12. Kramer IRH. Ameloblastoma: a clinicopathological appraisal.
Br J Oral Surg 1963; 1:13-28.
13. Marciani RD. Trodahl J N , Suckiel MJ, Dubick MN. Cryotherapy in the treatment of ameloblastoma of the mandible: report of
cases. J Oral Surg 1977; 35:289-295.
14. Mehlisch DR, Dahlin DC, Masson J K . Ameloblastom
icopathologic report. J Orul Sitrg 1972; 30:9-22.
15. Pandya NJ, Stuteville OH. Treatment of ameloblastoma. Plast
Rrconstr Surg 1972; 50:242-248.
16. Robinson HBG. Ameloblastoma: a survey of three hundred
and seventy-nine cases from the literature. Arch Potho11937;
23:83 1-843.
17. Robinson L, Martinez MG. Unicystic ameloblastoma. A prognostically distinct entity. Cur7cer 1977; 40:2278-2285.
18. Sehdev MK, Huvos AG, Strong EW, Gerold FP, Willis GW.
Ameloblastoma of maxilla and mandible. Cancer 1974; 33:324-333.
19. Shatkin S, Hoffmeister FS. Ameloblastoma: a rational
approach to therapy. O r d Surg 1965; 20:421-435.
20. Small IA, Waldron CA. Ameloblastomas of the jaws. Orul
Surg 1955: 8:281-297.
21. Stout RA, Lynch JB, Lewis SR. The conservative surgical
approach to ameloblastomas of the mandible. Plast Reconstr Surg
1963; 31:554-562.
22. Thoma K H . Oral Surgery. 5th ed. St. Louis: The C. V. Mosby
Co., 1969:987-1006.
22a. Tsaknis PJ, Nelson JF. The maxillary ameloblastoma: An
analysis of 24 cases. J OraI Surg 1980; 38:336-342.
2 3 . Vickers RA, Gorlin RJ. Ameloblastoma: delineation of early
histopathologic features of neoplasia. C ~ n c e r1970; 26:699-710.
24. Waldron CA. Ameloblastoma in perspective. J Orul Surg
1966; 24:331-333.