MANAGEMENT OF A RECURRENT MANDIBULAR UNICYSTIC AMELOBLASTOMA

Abstract

<h3>Background</h3> Ameloblastomas are benign, slow-growing odontogenic tumors with numerous subtypes based on clinical and histologic assessment. They account for approximately 1% of all oral tumors and are slow-growing, expansile lesions that can cause symptoms if they are sufficiently large or affect nearby structures. <h3>Case Report</h3> A 55-year-old female patient was referred to the Department of Oral and Maxillofacial Surgery (OMFS) at North Manchester General Hospital, United Kingdom, by her general dentist in 2009 regarding an extensive mandibular cyst associated with carious teeth. The cyst was enucleated under general anesthesia, and histopathology confirmed the diagnosis of a unicystic ameloblastoma. The patient was uneventfully followed up every six months for 7 years, which indicated continual healing and no signs of recurrence, after which the patient did not return for further review. In 2020, the patient was referred back to the OMFS department for a large swelling around the body of the mandible. An urgent biopsy was performed, which showed features consistent with recurrence of the ameloblastoma. Cross-sectional imaging was undertaken, and the patient's case was discussed at the head and neck multidisciplinary team meeting. Subsequently, the patient has been scheduled for segmental resection and reconstruction with a 3-dimensional chimeric scapula free flap. <h3>Discussion</h3> Eighty percent of all ameloblastomas occur in the mandible. The unicystic ameloblastoma is a variant of the intraosseous ameloblastoma and has the potential for recurrence after 10 years or more. <h3>Conclusions</h3> This case exemplifies the importance of careful and long-term follow-up of ameloblastomas, patient education, and the importance of histologic assessment for diagnosis.