Conservative management of a case of plexiform ameloblastoma

Ameloblastoma is a benign and locally aggressive neoplasm of odontogenic epithelium that has a wide spectrum of histologic patterns resembling early odontogenesis. It accounts for 1% of all tumours and cysts1 of the jaws and is the most common of all odontogenic tumours.2 It may arise from the enamel organ, epithelium of odontogenic cysts or from basal cells of the oral mucosa.3 Most cases affect mandibular molar and ramus regions.3 The tumour is usually asymptomatic and presents itself as a slowly enlarging facial swelling. It is a destructive tumour with a propensity for recurrence if not properly excised.4

A 9-year-old boy was referred from a local hospital to the Department of Paedodontics, Government Dental College, Trivandrum with pain and swelling in relation to the right side of the lower jaw. The patient had a history of surgery having been performed on the swelling at a local hospital. Patient records revealed that curettage had been performed on the lesion, following which a surgical drain and iodoform gauze pack were placed and changed at regular intervals. Histopathologic examination of the specimen reported an appearance consistent with a dentigerous cyst or unicystic ameloblastoma. An OPG (Figure 1) was taken which showed a large unilocular radiolucency with well-defined borders which extended from the distal aspect of the right deciduous second molar, involved the lower border of the mandible on the same side and the ramus up to the neck of the condyle. The crown of the second permanent molar appeared to be within the radiolucency, while the roots of the first permanent molar showed resorption. There was a radio-opaque mass in relation to the crown of the second permanent molar which seemed like a gauze pack. Clinically, slight expansion of the cortical bone was evident. Enucleation of the cystic mass (Figure 2) was performed, followed by a thorough curettage. The first and second permanent molars had to be extracted. Histopathologic examination of the specimen gave a diagnosis of plexiform type of ameloblastoma (Figure 3). An iodoform gauze pack was given which was changed every third day. The patient was reviewed every 3 months in the first year, every 6 months in the second and third year and annually in the following 2 years. Both clinical and radiographic examination showed evidence of healing (Figure 4).