Maxillary ameloblastoma: An enigma for the surgeon

Background:Ameloblastoma is a benign but locally aggressive odontogenic tumour. Worldwide, maxillary ameloblastoma is rare but its late detection renders adequate treatment difficult. Majority occur in the mandible with about 5-20% occurring in the maxillary bone. Objective: The purpose of this study was to analyze 21 cases of maxillary ameloblastoma seen and managed at the Oral and Maxillofacial Unit of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria and Alba Clinic and Medical Centre, Kaduna, Nigeria. Study Design:A retrospective study of cases of maxillary ameloblastoma from all cases of ameloblastoma seen from January 1993 to August 2008. Data with respect to patient's sex, age, tumour location, clinical presentation, radiologic features, biological and histopathologic type, surgical treatment and recurrences were analyzed. Results:Out of 350 cases of ameloblastoma seen within the period, 21(6%) Patients were with maxillary am eloblastoma. Of the 21 cases, there were 13 males and 8 females, a male female ratio of 1.6 to 1, with an age range of 17-55 years (mean = 38.14), peaking at the 4 th and 5 th decades of life (61.9%). Tumour duration was from 3 months to 14 years. There were 18 unilateral and 3 bilateral swellings. Clinically, maxillary ameloblastoma presented with grotesque swellings, with antral involvement in 19 cases, teeth mobility/exfoliation. Radiologically, there were 20 multilocular and 1 unilocular radiolucent lesions. The most common histopathologic type was follicular (11, 52.4%).there were 22 procedures done on 21 patients; 21 maxillectomies and 1 enucleation. Follow up period of 18 patients was between 3 months and 10 years from which 3(16.7%) recurrences were observed. Conclusion:Ameloblastum a is uncommon in the maxilla. While maxillary ameloblastoma is indistinguishable histologically from its mandibular counterpart, it is very lethal. An excellent result achieved in this study was due to the radical mode of treatment of the multilocular variety. Rehabilitation postoperatively remains a challenge. Periodic life-long follow-up is recommended.