Surgical challenges in the treatment of advanced cases of ameloblastoma in the developing world: The authors' experience

Total mandibulectomy was carried out in 32 patients with extensive orofacial lesions histologically diagnosed as ameloblastoma in four specialist centres in south-eastern Nigeria from January 2001 to December 2006. All the patients presented at an advanced stage with the whole mandible affected so the treatment of choice was total mandibulectomy. The patients gave informed consent for surgery. The standard surgical procedure was the same in all cases and was performed by the same surgeons. Of the 32 mandibles removed, there were 13 male (41%) and 19 female (59%) patients, giving a male-to-female ratio of 1:1.6. Three (9%) patients died due to problems relating to anaesthesia while five (16%) had postsurgical-related psychosomatic problems. Generally, the postoperative recovery was characterized by reduction in the quality of life of these patients because immediate jaw reconstruction was not feasible. This article highlights the challenges in the surgical management of advanced cases of ameloblastoma in the developing world and proposes a middle ground for professional interactions and exchange programmes among oral and maxillofacial surgeons across the world to assist poorer countries in the management of these advanced cases of oro-facial tumours.