Abstract

Background: Ameloblastoma is a benign neoplasm of odontogenic epithelial origin. One to three percent of tumors and cysts of the jaws are comprised of ameloblastomas. Its occurrence is considered a rarity in the younger age group. We present an unusual case of a large ameloblastoma of the anterior mandible in a 10-year-old child. Patient and Method: A 10-year-old male was referred to the department of oral and maxillofacial surgery in relation to a large (5.0 x 5.0 cm) swelling of the lower anterior jaw causing lower facial asymmetry. The patient suffered from difficulty in speech and eating due to a massive soft tissue overgrowth intra-orally occupying the anterior mandible and causing displacement of the anterior dentition. The segmental osteotomy of the entire anterior mandible including the lesion was done. The resulting defect was reconstructed using a 3D reconstructive titanium plate. Results: There was no postoperative infection or foreign body reaction during the 12-month follow up period. The lower facial asymmetry was restored and the patient was able to restore his speech and eating ability. Conclusion: The age, size, type and anatomic location of the tumour make it a rarity! To the best of our knowledge, this is the first report on the occurrence of a large, multicystic, ameloblastoma affecting the anterior lower jaw of a 10-year-old child.

Keywords: Ameloblastoma; Custom-made implant; 3D Printing; Mandible reconstruction

Introduction

Ameloblastoma is an aggressive, benign, epithelial odontogenic tumor that comprises 10% of the odontogenic tumors [1]. Histologically, the tumor is classified into a diversity of subtypes of which conventional (multi-cystic) and uni-cystic ameloblastomas are the most frequent [2]. They primarily occur in adults, with a minority occurring in the pediatric population (aged 18 and younger) [2].

Ameloblastoma can theoretically arise from remnants of the dental lamina, enamel organ of developing tooth, the epithelial lining of odontogenic cyst or basal cells of the oral mucosa [3]. It occurs in almost all age groups, but mainly diagnosed in the third or fourth decade of life. Most cases (66%) affect the posterior mandible and ramus [4]. Ameloblastomas are usually asymptomatic and present as a slowly growing facial swelling or as an incidental radiographic finding. Despite being a benign neoplasm, it is locally destructive and has a high rate of recurrence if not completely removed [5]. This study presents an unusual case of a large follicular ameloblastoma of the anterior mandible in a 10-year-old child.

Case Report

A 10-year-old male reported to the Department of Oral and maxillofacial surgery with an ulcerated large lump affecting the anterior mandible, which appeared two-years ago, as a small soft tissue peduncle. A dentist removed the soft tissue lesion without submitting it to histopathology. 12-months later, the lesion started to grow rapidly. Intra-oral examination indicated the presence of a large ulcerated swelling affecting the anterior mandible, measuring approximately 5.0 x 5.0 cm, and causing displacement of anterior dentition (Figure 1). A panoramic radiograph, performed by an oral and maxillofacial surgeon, showed multilocular radiolucency causing destruction of the entire anterior mandible (Figure 1). The case was miss diagnosed as a papilloma lesion. The histopathology outcome did not match the clinical and radiological picture. Hence, the biopsy has to be repeated at our department, which confirmed the diagnosis of a follicular multicystic ameloblastoma (Figure 1). The treatment plan included the resection of anterior mandible and reconstruction using 3D-reconstructive plate (implant) (Figure 2). The patient was offered to reconstruct the bony defect using a micro-vascualr Fibular flap. But the parents denied this treatment modality. 12-months regular follow up, showed no postoperative infection or foreign body reaction. The lower facial asymmetry was restored and the patient was able to restore his speech and eating ability.