Ameloblastoma - Ssdctumkur.org

CASE REPORT
Ameloblastoma
1 1
Chetan B.I , Vishwanath Hiremath
1 Department of Oral and
Maxillofacial Surgery
Uttaranchal Dental and
Medical Research Institute,
Dehradun.
JOURNAL OF DENTAL SCIENCES AND RESEARCH
Vol. 3, Issue 1, Pages 19-20
ABSTRACT
Ameloblastoma is a slow growing, locally aggressive, odontogenic tumor affecting the
maxilla and mandible with a propensity for recurrence. We report an ameloblastoma affecting
the mandible in a 56 year old male. The tumor was managed by surgical resection .
Key words: odontogenic tumour , ameloblastoma
INTRODUCTION
Ameloblastoma is an odontogenic tumor commonly
found in men and mandible. Even though it is a benign
tumor it is locally invasive. There are many histological
variants and all of them clinical present as slow growing
pain less swelling in the jaws. We report a case of an
ameloblastoma occurring in the mandible of a 56 year old
male.
CASE REPORT
A 56 years old male was reported our OPD complaining
of dull tooth ache in the lower left back teeth region. On
examination his face was asymmetrical due to a swelling
in the left mandibular ramus region. His medical and
personal history was unremarkable. He was moderately
built & moderately nourished. Extra orally tenderness
was elicited over left angle of mandible on palpation.
Submanidibular lymph nodes were palpable and tender
on the left side. TMJ was normal. Intra orally left
mandibular third molar was missing and second molar
was tender to percussion. OPG revealed large
multilocular radiolucaecies extending from distal of
mandibular second molar and extending posteriorly to
involve complete coronoid and condyle on left side of the
mandible. CT scan was done and revealed the same
lesion with involvement of the lower border of the
mandible (Figure 1). Under nasoendotracheal intubation
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E-mail: drvshiremath@gmail.com
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general anaesthesia was induced with the Risdon
Insulation, the affected part was exposed and mandible
was resected till 34 and titanium reconstruction plate
with condylar head was fixed and wound closed in layers
(Figure 2). Excised surgical specimen was sent for
histopathological investication and reported as follicular
ameloblastoma Patient recovered uneventfully. Patient
was on regular follow up for six months and noted that
there was no infection no exposure of the plate. Patient
was rehabilitated with prosthesis.
DISCUSSION
Ameloblastoma is slow-growing, locally invasive
odontogenic tumor with a high rate of recurrence.
Clinically they are seen as swellings is the jaws which are
generally asymptomatic. There are ten histological
variants (table 1), radiographically it can present as a
unilocular or multilocular radiolucenices. Irrespective
of the histological type their treatment involves surgical
excision the only distinction is to perform a conservative
surgical approach (enucleating and curettage) or a
radical surgical approach, recurrence rates depends upon
the type of intervention( conservative surgery recurrence
[ 1 ]
upto 90% and radical surgery upto 25%) .
[2]
Ameloblastoma are common in men and mandible .
Surgery for these tumors result in considerable amount of
tissue removal and require reconstructive surgeries and
rehabilitation. In the present case radical surgery with
rehabilitation was performed. It has been suggested
tumor angiogenesis may play an important role in locally
i n v a s i v e a g g r e s s i v e b i o l o g i c b e h a v i o r o f
[3]
ameloblastoma . Tissue engineering has been reported
to be useful in reconstructive surgery for management of
19

Journal of Dental Sciences and Research
[ 4 ]
ameloblastoma . Tumour suppressor genes,
ameloblastin, osteoclastic mechanism and matrix
metalloproteinases and other signalling molecules are
considered to be involved in the pathogenesis of
[5]
ameloblastoma .
Fig. 1 3D CT showing multilocular lesion is left ramus
of mandible
REFERENCES
1. Adebiyi KE, Ugboko VI, Omoniyi-Esan GO, Ndukwe KC,
Oginni FOClinicopathological analysis of histological
variants of ameloblastoma in a suburban Nigerian population.
Head Face Med. 2006 Nov 24;2:42.
2. Kim SG, Jang HS. Ameloblastoma: A clinical, radiographic,
and histopathologic analysis of 71 cases. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod. 2001;91:649–653.
3. Gadbail AR et al Tumor angiogenesis: Role in locally
aggressive biological behavior of ameloblastoma and
keratocystic odontogenic tumor. Head Neck. 2012 Mar 20. doi:
10.1002/hed.22960. [Epub ahead of print].
4. Hernandez-Alfaro F, Ruiz-Magaz V, Chatakun P, Guijarro-
Martinez R. Mandibular reconstruction with tissue
engineering in multiple recurrent ameloblastoma. Int J
Periodontics Restorative Dent. 2012 Jun;32(3):e82-6.
5. Gomes CC, Duarte AP, Diniz MG, Gomez RS Review article:
Current concepts of ameloblastoma pathogenesis J Oral Pathol
Med. 2010 Sep;39(8):585-91.
Fig.2 Post operative OPG showing titanium plate used for
reconstruction
Table 1 : Histological variants of ameloblastoma1
Follicular
Plexiform
Acanthomatous
Basal cell
Desmoplastic
Unicystic
Cystic / follicular
Follicular / Desmoplastic
Follicular / Acanthomatous
Follicular / Acanthomatous/Cystic
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