Painless mandibular expansion with tooth displacement
38-year-old female
§Chief complaint
Gradual swelling of the left lower jaw for 2 years
§Medical & dental history
- 01Nil relevant
- 02No previous malignancy
- 0336 extracted 3 years ago
- 04Socket reportedly never fully healed
§Clinical examination
- 01Bony hard, non-tender expansion of the left body of mandible, buccal and lingual
- 02Overlying mucosa intact; 37 grade II mobile and displaced
- 03Egg-shell crackling over the thinnest part of the buccal plate
- 04Lower lip sensation normal
§ figuresFigures (5)
Fig. 1Ameloblastoma
“Ameloblastoma” · Drg.AdiPratama · CC BY-SA 4.0 · Wikimedia Commons
Fig. 2エナメル上皮腫 濾胞型の組織像
“Ameloblastoma (Follicular Type)” · Baldanders · CC BY-SA 3.0 · Wikimedia Commons
Fig. 3ameloblastoma
“Ameloblastoma1” · Drg.AdiPratama · CC BY-SA 4.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Ameloblastoma figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Conventional (multicystic) ameloblastoma of the left mandible
Bicortical expansion, soap-bubble multilocularity and knife-edge root resorption of adjacent teeth are the discriminators against OKC. Incisional biopsy showing follicular islands with reverse polarity of peripheral ameloblast-like cells and stellate reticulum confirms it.
§Investigations
- 01OPG — multilocular soap-bubble radiolucency 55 mm, roots of 37 knife-edge resorbed
- 02CBCT — buccal and lingual cortical perforation in two areas, IAN canal displaced
- 03Incisional biopsy under LA
- 04Routine bloods and pre-anaesthetic workup
§Treatment plan
- 01Segmental mandibulectomy with 1.5 cm bony margins and one uninvolved anatomical barrier
- 02Immediate reconstruction with a free fibula flap
- 03Delayed implant-borne prosthetic rehabilitation
§Surgical procedure
- 01Virtual surgical planning with cutting guides
- 02Lip-split mandibulotomy avoided; submandibular approach used, IAN sacrificed on the affected side
- 03Segmental resection 35 to sigmoid notch; frozen section margins clear
- 04Double-barrel free fibula flap fixed with a 2.5 mm reconstruction plate, anastomosis to facial vessels
§Histopathology report
Follicular ameloblastoma: islands of odontogenic epithelium with peripheral tall columnar cells showing hyperchromatic nuclei polarised away from the basement membrane, central loosely arranged stellate reticulum, focal acanthomatous change. Bony margins free of tumour.
§Follow-up & outcome
- 01Flap viable; tracheostomy decannulated day 6
- 02Clinical and OPG review 3-monthly for 2 years, then 6-monthly
- 03Implants placed at 12 months; no recurrence at 4 years
§Clinical pearls / learning points
- 01Enucleation alone of a conventional ameloblastoma carries recurrence rates well over 50 percent.
- 02Unicystic mural-invasive variants behave more aggressively than luminal ones — read the histology carefully.
- 03Recurrence can appear more than a decade later, including inside a bone graft.
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Head and Neck Tumours
5th Edition — Volume 9
WHO Classification of Tumours Editorial Board · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 3
- L3 · Systematic review — 1
- L4 · Research — 2
- L6 · Textbook — 3
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
WHO Classification of Tumours Editorial Board. IARC / World Health Organization · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
Vered M, Wright JM. Head and neck pathology · 2022 · 16(1):63-75
Summary of odontogenic and maxillofacial bone tumour changes in the 5th edition WHO classification.
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Systematic Reviews & Meta-Analyses
Antonoglou GN, Sándor GK. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery · 2015 · 43(1):149-57
Systematic review comparing recurrence after conservative versus radical treatment of intraosseous ameloblastoma.
Key Research
Heikinheimo K, Huhtala JM, Thiel A et al.. Journal of dental research · 2019 · 98(1):54-60
Sequencing study characterising BRAF and other driver mutations in unicystic ameloblastoma.
Radiology References
Dunfee BL, Sakai O, Pistey R et al.. Radiographics : a review publication of the Radiological Society of North America, Inc · 2006 · 26(6):1751-68
Radiologic-pathologic correlation of benign and malignant odontogenic lesions of the jaws.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- WHO Classification of Head and Neck Tumours, 5th ed. (2022).
- Hendra FN et al. Global incidence and profile of ameloblastoma. Oral Dis. 2020.
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