Multicystic ameloblastoma in anterior region of the mandible treated by partial mandibulectomy

Abstract

Among all odontogenic tumors, multicystic ameloblastoma stands out as the most common one, originating from odontogenic epithelium, and despite these tumors are considered benign in nature, it shows a wide aggressive behavior, growing through the trabeculae of spongy bone. Diagnosing multicystic ameloblastoma is frequently challenging, nevertheless, modern imaginologic advents have demonstrating high accuracy. Due to its locally invasive behavior, management of multicystic ameloblastoma has been theme for controversies in literature, nevertheless, most of researches seem to agree that aggressive surgical resection is the most effective approach for this tumor. This paper reports an uncommon case of multicystic ameloblastoma occurring in the anterior mandible region of a female patient. Clinical main manifestation consisted on an extensive swelling in chin region, associated to a bone expansion in anterior lower alveolar bone. The patient reported the lesion has growing slowly, and have not manifested any episode of pain or sensitivity loss. Panoramic radiography analysis revealed an extensive lesion with honeycomb aspect in mental region of the mandible, while the computed tomography analysis showed the vestibular expansion of the tumor with several osseous septa into the lesion. Chosen treatment for the tumor was the partial mandibulectomy incorporation a risk-free bone border, aiming to avoid recurrence, once the literature points high rates of recurrence in ameloblastic tumors conservatively treated. After tumor removal with a 1.5 cm safe bone, histologic analysis revealed no tumor tissue presence on health bone margin, establishing a good prognosis with no recurrence. Moreover, diagnosis performed based on clinical-radiographical evaluation was satisfactory, leading us to the right diagnosis. This case elucidates that clinical and imaginologic evaluation of ameloblastoma tumors is reliable for clinicians to define the right diagnosis for these lesions. Furthermore, it shows multicystic ameloblastoma might be treated by partial mandibulectomy with a magin of healthy bone with low recurrence chances and satisfactory quality of life.