Comprehensive management of follicular ameloblastoma: Diagnostic and surgical strategies

INTRODUCTION

The epithelial remnants of the enamel organ give rise to the benign, locally aggressive odontogenic tumor known as ameloblastoma. If left untreated, it frequently affects the mandible and is characterized by poor growth and a high recurrence rate. Patients frequently describe pain, swelling, and altered sensation in the affected location, though clinical presentation can vary. The clinical, radiological, and histological findings of a patient with follicular ameloblastoma are described in this case study, with a focus on the difficulties in diagnosing the condition and its treatment options, including the use of surgery.^[1]

CASE REPORT

History and examination of the case report

A 45-year-old woman came in complaining of right facial puffiness that had been there for 1.5 years and chewing pain that had been there for 3 months. The patient had no prior history of toothaches, trauma, drainage, or a reduction in swelling size.

She was also known to chew pan and reported having a changed sensation over the right cheek area. Clinical examination showed a single, vague, diffuse swelling of 5 × 8 cm that extended mediolaterally 1 cm from the left corner of the mouth to the left lateral border of the mandible and superioinferiorly from the right pretragal region to the lower border of the mandible. The mucosa that covered the edema was stretched and had no subsequent alterations; it was the same color as the nearby mucosa. With the enlargement of the buccal and lingual cortical plates, its consistency was rigid and non-tender [Figure 1].

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Figure 1:

Clinical photograph showing the extraoral swelling on the right side of the patient’s face. The swelling is diffuse, non-tender, and hard on palpation.

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Findings from radiography and histopathology

A massive, well-defined, multilocular, radiolucent expansile lesion in the right mandibular body and ramus was discovered by panoramic radiography [Figure 2]. The diagnosis of follicular ameloblastoma was confirmed by an incisional biopsy, which showed the existence of follicles with a core of loosely distributed angular cells that resembled an enamel organ’s stellate reticulum. The center core was encircled by a single layer of tall, columnar cells that resembled ameloblasts. Some follicles formed microcysts, and the nuclei of these cells were positioned at the opposite pole from the basement membrane (reversed polarity).

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Figure 2:

Orthopantomogram revealing a large, well-defined radiolucent expansile lesion in the right body and ramus of the mandible with a multilocular appearance.

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Method of surgery

Under general anesthesia, the patient had the tumor surgically removed. Sufficient exposure was made possible by a submandibular incision that ran from the right pretragal area to the mandibular lower border. The marginal mandibular nerve was retained by careful dissection, and the mandible and lesion were revealed by cutting and reflecting the periosteum [Figure 3]. Hemimandibulectomy was perfomed by placing the incision beneath the mandible, with osteotomies made 1–1.5 cm outside the lesion to ensure clear margins. The remaining mandibular segments were stabilized by contouring and screwing a reconstruction plate. The epidermis, subcutaneous tissue, and periosteum were sutured in layers following irrigation of the operative site [Figure 4]. Following surgery, the patient was given RT feeding for 3 days to promote healing and antibiotic medication to prevent infection. Four-month follow-up showed no recurrence and satisfactory healing, proving the efficacy of the resection with sufficient margins and stabilization with a reconstruction plate.

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Figure 3:

Intraoperative photograph post-incision displaying the exposed mass. The lesion appears well-demarcated from the surrounding tissues.

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Figure 4:

Excised segment of the mandible, including the tumor, following hemimandibulectomy.

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DISCUSSION

Despite being benign, ameloblastomas present serious problems because of their high recurrence rate and aggressive local behavior. To avoid recurrence and possible complications, early discovery and thorough treatment – usually involving surgical resection with clear margins – are essential. Preventing recurrence and associated problems requires early discovery and thorough treatment, which usually entails surgical resection with clear margins. In patients who present with facial pain and swelling, this case emphasizes the value of a comprehensive clinical and radiographic evaluation, especially for those who have a history of behaviors like pan chewing that may have contributed to the development of such lesions.

Similar examples of ameloblastoma treated by surgical excision have been documented in a number of studies.^[2] For example, Carlson and Marx (2006)^[2] and Reichart et al.^[1] (1995) stressed the importance of attaining distinct surgical margins to lower recurrence rates. More recently, Pogrel (2015) highlighted better functional outcomes while discussing the effectiveness of surgical plates for mandibular stability after ameloblastoma resection. These examples support our methodology and results, highlighting the importance of precise surgery and thorough post-operative care.^[3]

CONCLUSION

This case illustrates follicular ameloblastoma’s clinical manifestation, diagnostic difficulties, and treatment approaches. To avoid recurrence and guarantee-positive patient outcomes, early diagnosis and suitable surgical intervention – including the insertion of reconstructive plates for stabilization – are crucial. Effective treatment of ameloblastoma requires multidisciplinary management, which includes clinical, radiographic, and histological examination. The surgical method used in this instance adds to the expanding corpus of research on optimal practices in maxillofacial surgery and shows an effective strategy for treating large mandibular ameloblastomas.