Ameloblastoma

Case contributed by Dr Lawrence Josey

Presentation

Incidental lesion found during routine dental review. Referred for investigation.

Patient Data

Age: 50
Gender: Male
Modality: X-ray

The opacities superimposed over the maxillary sinuses are ghost images of the ear piercings. There are recent sockets in the 15, 12 and 46 positions. The irregular multilocular lucency apical to the 45 and edentulous 46 position is suggestive of a developing bone/odontogenic lesion. The 45 root is intact with no obvious indications of resorption. The right inferior dental canal is obscured by the altered bone pattern. There is the suggestion of a residual periapical inflammatory lesion associated with the 46 in the apical region of the 46 mesial root. Comparison with previous radiographs would be of benefit in further assessment of this region. 

The maxillary third molars are impacted and the roots of these teeth appear in close relation to the floors of the respective maxillary sinuses. These teeth may be ankylosed. There is generalised loss of alveolar bone height in both arches and the presence of calculus is noted. Decay is most obvious in the 26, 27, 37 and 45. 

There is pocketing posterior to the 38 crown and a history of pericoronitis or the possibility of developing odontogenic pathology in the posterior left mandible cannot be excluded.

CT mandible

Modality: CT

Ameloblastoma as described below

Ameloblastoma diagnosed pre-operatively via biopsy, followed by resection.

Pathology report:

MACROSCOPIC

Right mandible short anterior, long lateral and consists of a segment of mandibular bone with a small amount of mucosa attached superiorly. Two premolars are present towards the anterior
superior end of the specimen. Sectioning reveals a bony lobulated, cystic cavity filled with firm tan to white tissue measuring 18mm in maximal dimension.

MICROSCOPIC

The intra-mandible tumour is confirmed to be a primary epithelial odontogenic tumour showing the features of an ameloblastoma. The tumour occupies and expands bone marrow space and focally extends into the overlying cortex but does not penetrate the cortical surface. The tumour extends around but does not infiltrate the intra-osseous nerve present. The tumour is completely excised with no tumour present in either en-face bone surgical resection margin.

SUMMARY
Right mandible: excised ameloblastoma.

Surgical details:

Tracheostomy through 2nd ring, isthmus divided and secured with silk. Right neck incision, submandibular gland removed. Marginal mandibular, lingual and hypoglossal nerves preserved. Mandibulectomy through canine and lower right second molar after plate prebent. 

Left composite radial free flap harvested inset to defect (4.5cm) tri med plate to left radius, closed. Full thickness skin graft, skin paddle to mouth anastamosis. artery end to end, facial vein 1 end to end, EJV cephalic end to side common facial. Closed. vicryl and clips.

Post op

Modality: X-ray

Right mandibulectomy and radial free flap (composite). Alignment is satisfactory. Mandible views not provided.

Case Discussion

This case illustrates the plain films and CT features of an ameloblastoma. 

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Case Information

rID: 18115
Case created: 10th Jun 2012
Last edited: 18th Dec 2015
System: Head & Neck
Inclusion in quiz mode: Included

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