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.
§References
- WHO Classification of Head and Neck Tumours, 5th ed. (2022).
- Hendra FN et al. Global incidence and profile of ameloblastoma. Oral Dis. 2020.
§Similar cases
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