Fact 7: The Surgical Narrative – AOT Management
The management of adenomatoid odontogenic tumors is a narrative of precision and deliberation. Surgical excision is the treatment modus operandi, meticulously planned and executed to remove the benign entity and restore the oral cavity’s form and function. The surgical journey begins with a thorough preoperative assessment, employing imaging and histological studies to map out the tumor’s extent and relationships with adjacent structures.
In the operating room, the surgeon’s narrative unfolds with the removal of AOT. For encapsulated variants like the follicular AOT, the goal is enucleation—careful dissection and removal of the tumor in its entirety. This approach is favored for its minimal invasiveness and excellent recovery outcomes. The surgeon’s skill in preserving vital structures while completely removing the tumor is paramount in preventing recurrence and ensuring optimal healing.
When dealing with the extrafolicular variant of AOT, the surgeon may need to adopt a more aggressive approach. The diffuseness of this variant can intermingle with the bone, making it challenging to ensure clear margins. In such cases, a more extensive surgical excision, potentially including the surrounding bone, may be required to achieve a tumor-free status.
For the peripheral AOT, surgical excision usually involves the gingiva and connected soft tissues. Here, the emphasis is on complete removal while maintaining the integrity and aesthetics of the gingival contour. Given its external position, the peripheral AOT often allows for a more straightforward surgical approach, with a focus on aesthetic restoration post-excision.
Postoperatively, the narrative continues with careful monitoring for signs of recurrence, although this is rare. The surgical management of AOT typically results in an uneventful recovery and an excellent prognosis. Patients can usually expect to return to normal function and appearance with minimal complications, a testament to the effectiveness of the surgical strategies employed in AOT management.
The surgical narrative for managing AOT is one of tailored approaches, informed by the variant and individual patient circumstances. The surgical chapter of AOT is predominantly one of success, with the careful application of knowledge and technique resulting in the favorable resolution of these benign tumors. The collaborative efforts of a multidisciplinary team ensure that the management of AOT is comprehensive and patient-centered, leading to outcomes that are both functionally and aesthetically pleasing. (7)
