GIANT AMELOBLASTOMA OF THE MANDIBLE ABBAS A , Renaux A , Pochan Y , Faye A , Sissoko B 1 2 3 2 2 1 ENT Resident of Marseille – CHU Timone - (France) firstname.lastname@example.org 2 Department of ENT – Hospital Principal – Dakar (Senegal) 3 Department of Stomatology – Hospital Principal – Dakar (Senegal) An ameloblastoma is an odontogenictumour of epithelial origin that can be locally aggressive, with avariety of histologic appearances. A relatively uncommon tumor(reported incidence: 3 per 10 million), it has a predilection forthe mandible, and it accounts for approximately 1% of alltumours and cysts that occur in the jaw.BACKGROUND: In developed countries, ameloblastoma isusually treated early, so these tumours do not normally reachsufficient size to qualify as a giant ameloblastoma jaw. We Fig 1a & 1b: giant ameloblastomareport the case of a 39-year-old woman who had a massive of the mandiblerecurrent ameloblastoma of the mandible. Our case is reportedbecause of its rarity, size, and management in under-medicalized countries, which involved radical resection.MATERIAL AND METHODS : A 39-year-old womanwas admitted to the hospital with an 8-year history of a growingmass in her left, with a recurrence after partial surgery –withoutprecision- 6 years ago (Fig 2). The tumour measured 20 x 12 x13 cm, blowed out the left hemi-mandible and the maxillarybone. It was firm, painless, polylobed, with a normal skin,and without nervous expression or cervical lymphaticmetastasis. CT-Scan showed a heterogenous and polycystic Fig 2: scar after prior partial surgerytumour, with several cortical disjunctions, blowing out the 6 years agomandible, the maxillary and palatine bones until thepterygopalatine area (Fig 3). Ameloblastoma was also heavilysuspected.RESULTS: Surgical management entailed the resectionof the entire left mandible and right symphysis, a part of themaxillary sinus and palatine process, not followed byreconstruction (Fig 4 & 5). There was no incident in postoperativedays and a second intervention of reconstruction wasscheduled (Fig 6a, 6b & 6c). Nevertheless the patient had nevercome. Fig 3: CT Scan: polycystic pattern The pathological study revealed a of ameloblastoma
DISCUSSION: In third world countries, ameloblastomadistinguishes by its volume on patients with a poor buccodentalhygiene [1,2].Literature reports that: - most common neoplasm arising from the primary odontogenic, or tooth forming tissue; expand within the jaw and displace bone, teeth, and roots - slow growing non-encapsulated tumours, usually asymptomatic until large size is achieved  - high frequency in African countries [1,2] Fig 4: per-operative aspect - 3 histological patterns: follicular, plexiform and mixed [4, 5] - 3 radiological patterns: polycystic, monocystic and solid  - mandibular localization: 85% of cases  - some patterns more reccurent: polycystic and follicular: our case Fig 5: giant ameloblastoma measuring 20 x 12 x 13 cm→ Diagnosis relatively clear in patients with jaw masses of this extremesize and with characteristic findings on imaging studies.→ Differential diagnosis: fibrous dysplasia or histiocytosis→ Therapy for giant ameloblastoma =>surgical resection → Enucleation inadequate for large lesions ( high rate of recurrence ):bony surgical margins of 1 to 2 cm recommended → Caution should be exercised, however, becausehistologic transformation can occur (both metastatic andmalignant transformation potential) [7,8]CONCLUSION: This case report illustrates the importance of adequate radical resection to avoid recurrence. Therefore,it is important to emphasize the need for long termperiodic follow-up which is very difficult in under- Fig 6a, 6b & 6c: postoperative aspect: without reconstructionmedicalized countries. Ameloblastoma implicates also ABSTRACTdiagnosis and therapeutic challenges in these countries. REFERENCES The authors report a historical case of a recurrent giant  GADEGBEKU AS, CREZOIT GBE, ADOU A, ANGOH Y, MAREGA FB. L’améloblastome en milieu africain. Rev Stomatol Chir Maxillofac 1994;95:70-73. ameloblastoma of the mandible. Six years ago a recurrence  CHIDZONGA MM, LOPEZ PEREZ VM, PORTILLA ALVAREZ AL. Ameloblastoma: the appeared after partial surgery, this ameloblastoma developed Zimbabwean experience over 10 years. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:38-41. from the left half-mandible blowing out the mandible and the  DUPUIS A, DINER PA, MICHAUD J. Améloblastome géant. A propos d’un cas de Maxillary bone. The pathological study revealed a follicular localisation mandibulaire. Rev Stomatol Chir Maxillofac. 1983;84:218-21.  OLAITAN AA, AROLE G, ADEKEYE EO. Recurrent ameloblastoma of the jaws. A ameloblastoma without character of malignity. This follow-up study. Int J Oral Maxillofac Surg. 1998;27:456-60. unusual case points out to us the therapeutic difficulties at the  KIM SG, JANG HSJ. Ameloblastoma: a clinical, radiographic, and histopathologic analysis of 71 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:649-53. time of the recurrences of ameloblastomas on the one hand  NAKAMURA N, HIGUCHI Y, MITSUYASU T, SANDRA F, OHISHI M. Comparison of and the difficulties of follow-up of patients in tropical area long-term results between different approaches to ameloblastoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:13-20. on the other hand.  ROBINSON HBG. Ameloblastoma: a survey of three hundred and seventy-nine cases from the literature. Arch Pathol 1937;23:831-43.  SLOOTWEG PJ, MULLER H. Malignant ameloblastoma or ameloblastic carcinoma. Oral Key words: ameloblastoma, mandible, recurrence, giant Surg 1984;57:168-76. tumor, surgery.