A case report on Ameloblastoma.

2. AMELOBLASTOMA
A Case Report
Presented by:
Megha Shaju
House surgeon
Sri Siddhartha Dental College & Hospital,

3. Patient Profile
Name:Jyothi
O.P Number:488481
Age:35 years
Sex:Female
Address:C.N halli
Occupation:House Wife

4. CASE HISTORY
Chief Complaint:
• Patient complaints of swelling in her lower left back
teeth region since 2 years.
History of presenting illness:
• Initially it started as a small swelling of pea nut size and
gradually attained a big size,which was neither
associated with pain nor with discharge.
• Patient gives a history of spontaneous exfoliation of
tooth in the region.

5. PastMedicalHistory:
Nonereportedbythepatient
Past Dental History:
None reported by the patient.
Personal History:
Diet:Mixed
Appetite:Normal
Micturition:Regular
Bowel and Bladder:Regular
Sleep:Normal
Habits:No deletorious habits reported

6. ClinicalExamination
General Physical examination:
Patient is well built,well nourished and well oriented to
time,place and person.
Vital Signs:
Pulse:72 beats/minute
Respiratory Rate:16 cycles/minute
Blood Pressure:110/78 mm of hg
Temperature:Afebrile

7. Pallor:Absent
Icterus:Absent
Cyanosis:Absent
Clubbing:Absent
Lymphadenopathy:No lymphadenopathy present
Edema:Absent
Extra Oral Examination
Facial Asymmetry:No gross asymmetry present.
TMJ:No abnormality detected
Lymph nodes:Non palpable

8. HardtissueExamination:
TeethPresent:
18171615141312112122232425262728
484746454443424131323334353637
Local Examination of the lesion:
Inspection
• A well defined solitary swelling present on the lower left
back teeth region;ie,distal to 37.
• Anteroposteriorly,extending from distal of 37 to the
pterygomandibular raphe of the affected side.
• Buccolingually,it involves buccal cortical plate and lingual
cortical plate

9. • Thelingualcorticalplateexpansioncanbeseen.Noexpansion
notedinbuccalcorticalplate.
• Superoinferiorly,it extends 1 cm above the occlusal plane
to the mucogingival junction.
• Superobucally there is a depression seen due to the
indentation of opposing teeth.
• The overlying mucosa was normal in colour.
Palpation
• The swelling is non tender and hard in consistency.

10. CASE SUMMARY
A patient named Jyothi,aged 37 years old,reported to the
department with a chief complaint of swelling in her lower left
back teeth region since 2 years.Patient gave a history of
spontaneous exfoliation of tooth from the region.According to the
patient,it started as a small swelling of pea nut size and gradually
enlarged to the present size.On Inspection,a well defined solitary
swelling noticed in the lower left back teeth region,distal to
37.Anteroposteriory extending from distal side of 37 to the
pterygomandibular raphe.Expansion of lingual cortical plate was
also noted.Superoinferiorly it extends 1 cm above the occlusal
plane to the mucogingingival junction.On palpation,the swelling
was non tender and hard in consistency.On radiographic
examination,multilocular radiolucency noted in the left mandible
extending from middle of ramus of mandible to angle of mandible
to half the body of mandible.

11. ProvisionalDiagnosis:
Ameloblastomaintheleftsideofmandible.
Differential Diagnosis:
• Ameloblastic fibroma
• Giant cell granulomas
• Odontogenic myxoma
Investigations
• Incisional biopsy
• Vitality test irt 37
• Radiography(Orthopantomogram)

12. Radiographicinvestigation:

13. • OPGshowsmultilocularradiolucencyintheleftsideofthe
mandible.
• It extends from the middle part of ramus to the angle of
the mandible,to half the body of mandible(left second
premolar ie,35).
• Multilocualr radiolucency, in the form of tennis racket
apperance is seen in the apical root area of 35 and 36,
continues to give a soap bubble appearance from root of
37 to body of mandible.
Final diagnosis:
Ameloblastoma in the left side of mandible

14. CASE DISCUSSION
Ameloblastoma is an aggressive neoplasm that arises from
remnants of the dental lamina and dental organ(odontogenic
epithelium).
Clinical features
• Slight predilection for this lesion to occur in men and
develops more often in African Americans.
• Most cases occuring in patients between 20 and 50 years of
age.(although it may be found in young children of 3 years
and in individuals older than 80 years).
• Most commonly seen in posterior mandible ,but may also
arise in maxilla and anterior aspect of jaws.
• Ameloblastomas grow slowly,and few,if any,symptoms
occur in the early stages.
• Patient eventually notices gradually increasing facial
asymmetry.
• In 95% of untreated maxillary ameloblastomas ,swelling of
cheek,gingiva or hard palate has been reported.

15. • The mucosa over the mass is normal,but teeth in the involved
region may be displaced and become mobile.
• In most of the cases patients do not have
pain,paresthesia,fistula,ulcer formation or tooth mobility.
• As the tumor enlarges,palpation may elicit a bony hard
sensation or crepitus as the bone thins.
• If the tumor destroys the overlying bone,the swelling may feel
firm and fluctuant.
• As it grows,this tumor can cause bony expansion and
sometimes erosion through the adjacent cortical plate with
subsequent invasion of adjacent soft tissues.
• An untreated tumor may grow to a great size and it can extend
to vital structures,more of a concern in the maxilla.
• Recurrence rates are higher in older patients.
Radiographic features
• Radiographic apperance ranges from unilocular to multilocular
radiolucency.
• Usually periphery is well defined and frequently delineated by a

16. • The border is often curved ,and in small lesions the border and
shape may be indistinguishable from a cyst.
• The internal structure varies from totally radiolucent to mixed
with the presence of bony septa creating compartments.
• These septa can be straight but more commonly coarse and
curved.
• These septa are often remodeled into curved shapes providing
honey comb (numerous small compartments or loculations)or
soap bubble (larger compartments of variable size)patterns.
• Pronounced tendency to cause extensive root resorption.
• Tooth displacement is common.
• Occlusal radiograph may demonstrate cystlike expansion and
thinning of an adjacent cortical plate leaving a thin “eggshell”of
bone.
Treatment
The most common treatment is surgical resection.If it is small,it
may be removed completely by intraoral approach,and larger
lesion requires resection of jaw.Radiation therapy may be used

17. AMELOBLASTICFIBROMA
Ameloblasticfibromasarebenign,mixedodontogenic tumors.Itis
composedofmesenchymaltissueresemblingdentalpapillaeandsmall
islandsofodontogenicepitheliumresemblingdentallamina.
Clinical features
• Most cases of this tumor are in patients under 20 years of
age,particularly very young children,and congenital cases have
been reported.
• The most common location is the mandibular premolar and
molar region.
• They usually produce a painless,slow growing expansion and
displacement of the involved teeth.

18. • Asitenlargesbygradualexpansion,theperipheryofthe
lesionremainssmooth.
• It is mostly asymptomatic and has been discovered
accidentally during radiographic examination.
• Pain,tenderness or mild swelling of the jaw may present
often.
Radiogarphic features
• The borders of ameloblastic fibroma are well defined and
often corticated in a manner similar to that of a cyst.
• It is more commonly unilocular but may be multilocular
with indistinct septa.

19. • Ifthelesionislarge,theremaybeexpansionwithanintact
corticalplate.
• The associated tooth or teeth may be inhibited from
normal eruption or may be displaced in an apical
direction.
Treatment
A conservative surgical approach,including enucleation and
mechanical curettage of the surrounding bone,is reported
to be successful.