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Is Less More? A conservative multidisciplinary approach to ameloblastoma Hussein Mohamedbhai Debipriya Dasgupta Charlotte Hubbett Nayeem Ali Dental Update 2024 47:6, 707-709.
This case report outlines a novel conservative surgical approach to the management of a unicystic ameloblastoma with the use of marsupialisation, enucleation, cryotherapy and orthodontic extrusion to enable successful treatment without neurological damage or deformity. It has been increasingly recognized that conservative treatment of unicystic ameloblastomas, instead of wide local excision, can reduce morbidity whilst maintaining an acceptably low recurrence rate. Several case series have also demonstrated orthodontic extrusion of impacted third molars in moving the apex of the roots away from the inferior alveolar nerve. This is possibly the first case report of the combination of these two procedures in an adult with a large unicystic ameloblastoma.
CPD/Clinical Relevance: This is not an infrequently seen neoplasia: this paper therefore has the opportunity to inform management of this condition amongst clinicians.
Article
CH, a 22 year-old woman, presented via her general dental practitioner (GDP) with an asymptomatic swelling, which was noted on routine examination. There was no relevant medical history and no family history to note. She had never smoked and only drank alcohol occasionally. On examination, she was found to have a hard mass, along the posterior lower right buccal sulcus of the lower right second molar (LR7) extending to the alveolar ridge. This mass was tender to palpation. The LR7 was vital and the lower third molar (LR8) unerupted. Otherwise the examination was normal and there was no palpable cervical lymphadenopathy.
A radiographic image (Figure 1) demonstrated a unilocular, well-corticated radiolucency measuring 40 mm in diameter extending from distal of the LR7 to the angle of the mandible and 50% of the ramus. Although some characteristics were typical of a dentigerous cyst, the margins of the cyst seemed to be in contact with the cemento-enamel junction of the unerupted LR8. Other features were atypical, including the resorption of the distal root of the LR7. In addition, the cyst showed evidence of causing displacement of the LR8 distally. CT imaging (Figure 2) demonstrated that the lingual plate and mandibular cortical border were intact, as well as showing the inferior alveolar nerve was buccal to the LR8. Incisional biopsy of the abnormality and aspiration of its contents demonstrated the histological findings of a cyst lined by thin odontogenic epithelium. The stroma showed myxoid changes with nests of both active and resting odontogenic epithelium. A diagnosis of unicystic ameloblastoma was made.
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