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Giant Mandibular Ameloblastoma
IMAGES IN THE MEDICAL SCIENCES
Giant Mandibular Ameloblastoma Maher Abouda, MD*, Senda Turki, MD and Khadija Billil, PhD *
Faculty of Medicine, Department of Respiratory Medicine, F.S.I. Hospital, University of Tunis El-Manar, Tunis, Tunisia (E-mail: [email protected]). The authors have no financial or other conflicts of interest to report.
FIGURE.
CASE PRESENTATION
A
28-year-old African woman presented with a giant painless mass in the left mandible for 8 years. The mass had gradually developed after the extraction of a left inferior premolar. The ovoid swelling was well-limited, nontender and measured 24 cm 18 cm 15 cm, extending to the lower orbital margin and involving the complete left side of the jaw. Computed tomography scan demonstrated the presence of a multilocular cystic mass located on the left side of the mandible passing over the median line, invading the left maxillary sinus and preserving the floor of the left orbit (Figure A). The treatment was subtotal segmental mandibulectomy (Figure B) with immediate reconstruction using a nonvascularized bone graft from the iliac crest. The pathologic examination confirmed the diagnosis of a benign predominantly follicular ameloblastoma (Figure C). Good postoperative functional and esthetic results were obtained. Ameloblastoma or adamantinoma is a locally aggressive and histologically benign tumor of the jaw, arising from the oral ectoderm.1,2 It accounts for 1% of all maxillomandibular and oral tumors and constitutes about 10% of odontogenic tumors.3 It has a high rate of local recurrence that can reach up to 50% when treated inadequately and can become malignant in less than 1% of cases.1,3 This epithelial odontogenic neoplasm, more
common in the ascending ramus mandible, is usually slow growing but occasionally reaches gigantic size.1 Approximately one-third of the patients are asymptomatic, and diagnosis is usually made during radiographic examination for another reason. However, patients can experience pain, paresthesia, swelling, dental malocclusion and facial deformities, particularly with giant ameloblastomas. In computed tomography scan of the maxillofacial area, giant ameloblastoma appears as a well-limited unilocular or multilocular, cystic or solid lesion with a thin wall.1 Treatment is primarily surgical, either conservative or radical, depending on the experience of the surgeon and progression characteristics of the tumor.2 The best modality of surgical treatment for giant ameloblastoma is radical excision with immediate reconstruction using a free flap.
REFERENCES 1. Bhandarwar AH, Bakhshi GD, Borisa AD, et al. Anterior mandibular ameloblastoma. Clin Pract 2012;2(1):e30. 2. Chaine A, Pitak-Arnnop P, Dhanuthai K, et al. A treatment algorithm for managing giant mandibular ameloblastoma: 5-year experiences in a Paris university hospital. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 2009;35(9):999–1005. 3. Vayvada H, Mola F, Menderes A, et al. Surgical management of ameloblastoma in the mandible: segmental mandibulectomy and immediate reconstruction with free fibula or deep circumflex iliac artery flap (evaluation of the long-term esthetic and functional results). J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg 2006;64(10):1532–9.
Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved. www.amjmedsci.com www.ssciweb.org
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Giant Mandibular Ameloblastoma Maher Abouda, MD*, Senda Turki, MD and Khadija Billil, PhD *
Faculty of Medicine, Department of Respiratory Medicine, F.S.I. Hospital, University of Tunis El-Manar, Tunis, Tunisia (E-mail: [email protected]). The authors have no financial or other conflicts of interest to report.
FIGURE.
CASE PRESENTATION
A
28-year-old African woman presented with a giant painless mass in the left mandible for 8 years. The mass had gradually developed after the extraction of a left inferior premolar. The ovoid swelling was well-limited, nontender and measured 24 cm 18 cm 15 cm, extending to the lower orbital margin and involving the complete left side of the jaw. Computed tomography scan demonstrated the presence of a multilocular cystic mass located on the left side of the mandible passing over the median line, invading the left maxillary sinus and preserving the floor of the left orbit (Figure A). The treatment was subtotal segmental mandibulectomy (Figure B) with immediate reconstruction using a nonvascularized bone graft from the iliac crest. The pathologic examination confirmed the diagnosis of a benign predominantly follicular ameloblastoma (Figure C). Good postoperative functional and esthetic results were obtained. Ameloblastoma or adamantinoma is a locally aggressive and histologically benign tumor of the jaw, arising from the oral ectoderm.1,2 It accounts for 1% of all maxillomandibular and oral tumors and constitutes about 10% of odontogenic tumors.3 It has a high rate of local recurrence that can reach up to 50% when treated inadequately and can become malignant in less than 1% of cases.1,3 This epithelial odontogenic neoplasm, more
common in the ascending ramus mandible, is usually slow growing but occasionally reaches gigantic size.1 Approximately one-third of the patients are asymptomatic, and diagnosis is usually made during radiographic examination for another reason. However, patients can experience pain, paresthesia, swelling, dental malocclusion and facial deformities, particularly with giant ameloblastomas. In computed tomography scan of the maxillofacial area, giant ameloblastoma appears as a well-limited unilocular or multilocular, cystic or solid lesion with a thin wall.1 Treatment is primarily surgical, either conservative or radical, depending on the experience of the surgeon and progression characteristics of the tumor.2 The best modality of surgical treatment for giant ameloblastoma is radical excision with immediate reconstruction using a free flap.
REFERENCES 1. Bhandarwar AH, Bakhshi GD, Borisa AD, et al. Anterior mandibular ameloblastoma. Clin Pract 2012;2(1):e30. 2. Chaine A, Pitak-Arnnop P, Dhanuthai K, et al. A treatment algorithm for managing giant mandibular ameloblastoma: 5-year experiences in a Paris university hospital. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 2009;35(9):999–1005. 3. Vayvada H, Mola F, Menderes A, et al. Surgical management of ameloblastoma in the mandible: segmental mandibulectomy and immediate reconstruction with free fibula or deep circumflex iliac artery flap (evaluation of the long-term esthetic and functional results). J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg 2006;64(10):1532–9.
Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved. www.amjmedsci.com www.ssciweb.org
223