World Journal of Pharmaceutical Research

Jaseem et al. World Journal of Pharmaceutical Research

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Volume 4, Issue 12, 2032-2034. Caes Report ISSN 2277 7105

A CASE REPORT ON AMELOBLASTOMA

Jaseem Sabith K*1, Linu Mohan P1, Nayana S.A1, Nathaliya P.M1,
Dr. Mohamed Yahiya2

1
Department of Pharmacy Practice, Al Shifa College of Pharmacy, Perinthalmanna.
2
Department of Maxillo Facial Surgery, Kims Al Shifa Hospital, Perinthalmanna.

INTRODUCTION
Article Received on
18 Oct 2015, Ameloblastomas are benign tumors whose importance lies in its

Revised on 10 Nov 2015,

potential to grow to enormous size with resulting bone deformity.
Accepted on 02 Dec 2015 Ameloblastomas originate from the epithelium involved with the
formation of teeth: enamel organ, odontogenic rests of Malassez,

*Correspondence for reduced enamel epithelium and odontogenic cyst lining.

Author Ameloblastomas are usually asymptomatic and found on routine dental
Jaseem Sabith K. radiographs.[1] They may also present with jaw expansion. Several
Department of Pharmacy
authors describe possible pathogenic mechanisms that include
Practice, Al Shifa College
nonspecific irritants such as extraction, caries, trauma, infection,
of Pharmacy,
Perinthalmanna. inflammation, or tooth eruption, nutritional deficit disorders and viral
pathogenesis. The median age in ameloblastoma is 36 years, with a
range of 10 - 90 years.[2] The tumor occurs mainly in younger patients in developing
countries. Men and women are equally affected. While cases have been reported from almost
all parts of the world, a higher number of cases occur in Japan, Nigeria and U.S.A. and fewer
cases in Australia and South America. Of all oral and maxillofacial pathology, prevalence of
odontogenic tumor is 0.8% and ameloblastomas contribute its 30%.[3,4] The ratio of
ameloblastoma of the mandible to maxilla is 5 to 1. Treatment of ameloblastomas is primarily
surgical. There has been some debate regarding the most appropriate method for surgical
removal of ameloblastomas.[5] These range from conservative to radical modes of treatment.
The conservative modalities include curettage, enucleation and cryosurgery; while the radical
modalities are marginal, segmental and composite resections. There is a lack of consensus
over the most appropriate treatment modality. Here we report a case of ameloblastoma with
multilocular radiolucent cyst.

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Jaseem et al. World Journal of Pharmaceutical Research

CASE REPORT
A 26 year old male patient reported to the Maxillofacial Surgery Department of a tertiary care
hospital, Kerala, India, with chief complaints of deep pain, discomfort and swelling in the left
submandibular region. There was no history of any discharge and paresthesia but patient felt
difficulty in talking, chewing or articulating. Two years back patient had a history of surgery
for cystic ameloblastoma. There was no abnormality on systemic examination and past
family history of patient was non-contributory. The images provided by panoramic
radiography and computed tomography (CT) showed a multilocular radiolucent cyst, located
in the left body of the mandible. No evidence of neoplasm confirmed by histopathological
examination. The selected treatment planning was resection of mandible and reconstruction
with rib graft. Under general anesthesia, left angle and body region were exposed by both
intra oral and submandibular approach. Block dissection of upper border done and lower
border of the mandible was preserved and chemical cauterization. Layered suturing was done.
Postoperative period was uneventful with good aesthetic and functional final results.

DISCUSSION
Ameloblastoma in the mandible can progress to great size and cause facial asymmetry,
displacement of teeth, loose teeth, malocclusion, and pathologic features. In choosing a
treatment the clinical type, localization, size of tumor, recurrence and age of patient should be
assessed.[6] Histopathology report on April 2012 showed a cystic variant ameloblastoma and
had a surgery for the same. Patient didnt show any sign and symptoms for the last one and
half years.

Six month back patient showed the signs of recurrence,[5] as suggested by A Kahairi and
colleagues.[7] He felt deep pain, discomfort and swelling in the left submandibular region but
no history of any discharge and paresthesia. Patient had difficulty in talking, chewing or
articulating. A mandible CT scan on February 2014 showed an expansile non-enhancing
lesion in left mandible. Surgical excision with wide free margins is the treatment of choice
for recurrence of ameloblstoma.

Here the patient was undergone with resection of mandible and recurrence rate is less for
surgical approach. Eppley (2002) in his review of 60 mandibular ameloblastoma cases have
shown that there was no recurrence of those cases treated via en bloc resection as compared
to enucleation and curettage in which the recurrence rate was high as 25% to 50 %. [7] Since
the patient had a thick and healthy mandible the reconstruction was unnecessary.

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Jaseem et al. World Journal of Pharmaceutical Research

COCLUSSION
Ameloblastomas are benign tumors represents 6-25% of oral tumors and originate from the
epithelium involved with the formation of teeth. It shows a potential to grow to enormous
size with resulting bone deformity. Even though many options are available for the treatment
of ameloblastoma surgery is the treatment of choice especially to avoid the recurrence. This
article highlights the importance of surgery in ameloblastoma management.

REFERENCE
1. Paikkatt VJ, Sreedharan S, Kannan VP. Unicystic ameloblastoma of the maxilla: a case
report. J Indian Soc Pedod Prev Dent., 2007 June; 106-10.
2. Rajendran R. Cysts and tumors of odontogenic origin. In: Rajendran R,
Sivapathasudharam B. Shafers text book of oral pathology. Elsvier; 6th ed. p. 270-75.
3. Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults
over a 30-year period. Journal of Oral Pathology and Medicine., 2006; 35(7): 392-401.
4. Beena VT, Choudhary K, Heera R, Rajeev R, Sivakumar R, Vidhyadharan K. Peripheral
ameloblastoma: a case report and review of literature. Case Reports in Dentistry., 2012.
p.1-3 doi: 10.1155/2012/571509.
5. Malheiro P, Feio L, Costa H. Unicystic plexiform ameloblastoma case report. Revista
De Saude Amato Lusitano., 2013; 32: 52-54.
6. Gadda RB, Patil N, Salvi R. Multilocular radiolucency in the body of mandible: a
systematic diagnostic approach. Journal of Contemporary Dentistry, 2012 May-August;
2(2): 39-42.
7. Kahairi A, Ahmed RL, Islah LW, Norra H. Management of large mandibular
ameloblastoma a case report and literature review. Archives of Orofacial Sciences.
2008; 3(2): 52-55.

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