›› 2021, Vol. 41 ›› Issue (12): 1104-1110.

• Clinical Research • Previous Articles     Next Articles

Effect of decompression combined with secondary surgery in the treatment of jaw ameloblastoma: a clinical retrospective study

  

  • Received:2021-08-05 Revised:2021-10-12 Online:2021-12-28 Published:2021-12-31
  • Contact: Zhi-Yong -Wang E-mail:Wangzhiyong67@163.com

Abstract: Objective: To study the efficacy of decompression combined with secondary surgery, curettage and resection in the treatment of jaw ameloblastoma (AM), and to provide reference for the selection of clinical treatment. Methods: A retrospective analysis of 92 patients with AM in the jaw was performed, and measured by image j software, using paired t-test and chi-square test to analyze the effective rate of decompression combined with secondary surgery, jaw recovery and inferior alveolar nerve injury rate. The recurrence rate of patients with AM in the jaw was evaluated using chi-square test, cox multifactor regression model and Kaplan-Meier method to investigate the effect of age, site of onset, different surgical methods, gender and histopathological typing on the recurrence rate. The effective rate of fenestration, the amount of jaw recovery and the injury rate of inferior alveolar nerve were analyzed by image j software. Results: The age distribution of 92 patients ranged from 8 to 76 years, of which 16 were 0-20 years old; 42 were 20-40 years old, and 34 were over 40 years old. Gender distribution was 54 males and 38 females. According to clinical classification, 33 cases were divided into single cyst type and 59 cases were classic type. According to histopathology, they were divided into single cyst type: 33 cases; follicular type: 28 cases; plexiform type: 24 cases; basal cell type: 5 cases; acanthoma type: 1 case; granular cell type: 1 case. 42 cases underwent curettage alone; 25 underwent resection alone; 25 underwent decompression combined with secondary surgery. The effective rate of measurable patients was 77.8% and the average reduction ratio of the lesion was 52.7% in patients who used decompression treatment (P <0.05). In 14 patients with measurable AM of jaw, the thickness of the thinnest jaw near the tumor cavity was less than 5mm before decompression and recovered to more than 5mm after decompression (P < 0.05). The lower lip numbness rate of patients who used decompression combined with secondary curettage for AM of the mandible was 31.6%, and the numbness of the lower lip after treatment with simple curettage was 36.1% (P > 0.05). The recurrence rate of decompression combined with secondary curettage (21.05%) was lower than that of curettage alone (54.76%) (P < 0.05). The recurrence rate of simple resection (24%) was lower than that of simple curettage (54.76%). Gender, age, pathological classification, pathogenesis, multi-factor Cox regression inspection of the surgical method, showed that these factors have no statistically significant impact on the recurrence of jaw AM (P> 0.05). The 3-year cumulative recurrence rates of curettage, decompression combined with secondary curettage and resection were 24.39%, 16% and 4%, respectively. Conclusions: Decompression can reduce the tumor cavity area of jaw ameloblastoma and increase bone thickness, which is beneficial to the preservation of jaws of patients with ameloblastoma. Decompression does not increase the risk of recurrence of Second stage operation. Decompression can reduce the lumen area of AM and increase bone thickness, which is beneficial for jaw bone preservation in patients with AM. Also, decompression combined with secondary curettage and direct resection compared with simple curettage could reduce the recurrence rate of AM.

Key words: decompression, ameloblastoma, recurrence rate, resection, secondary operation, curettage

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