Case-report of a giant ameloblastoma operated in Senegal

1. 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) aliabbas@yahoo.fr 2
Department of ENT – Hospital Principal – Dakar (Senegal)
3
Department of Stomatology – Hospital Principal – Dakar (Senegal)
An ameloblastoma is an odontogenic
tumour of epithelial origin that can be locally aggressive, with a
variety of histologic appearances. A relatively uncommon tumor
(reported incidence: 3 per 10 million), it has a predilection for
the mandible, and it accounts for approximately 1% of all
tumours and cysts that occur in the jaw.
BACKGROUND: In developed countries, ameloblastoma is
usually treated early, so these tumours do not normally reach
sufficient size to qualify as a giant ameloblastoma jaw. We
Fig 1a & 1b: giant ameloblastoma
report the case of a 39-year-old woman who had a massive of the mandible
recurrent ameloblastoma of the mandible. Our case is reported
because of its rarity, size, and management in under-
medicalized countries, which involved radical resection.
MATERIAL AND METHODS : A 39-year-old woman
was admitted to the hospital with an 8-year history of a growing
mass in her left, with a recurrence after partial surgery –without
precision- 6 years ago (Fig 2). The tumour measured 20 x 12 x
13 cm, blowed out the left hemi-mandible and the maxillary
bone. It was firm, painless, polylobed, with a normal skin,
and without nervous expression or cervical lymphatic
metastasis. CT-Scan showed a heterogenous and polycystic Fig 2: scar after prior partial surgery
tumour, with several cortical disjunctions, blowing out the 6 years ago
mandible, the maxillary and palatine bones until the
pterygopalatine area (Fig 3). Ameloblastoma was also heavily
suspected.
RESULTS: Surgical management entailed the resection
of the entire left mandible and right symphysis, a part of the
maxillary sinus and palatine process, not followed by
reconstruction (Fig 4 & 5).
There was no incident in postoperative
days and a second intervention of reconstruction was
scheduled (Fig 6a, 6b & 6c). Nevertheless the patient had never
come.
Fig 3: CT Scan: polycystic pattern
The pathological study revealed a
of ameloblastoma

2. DISCUSSION: In third world countries, ameloblastoma
distinguishes by its volume on patients with a poor buccodental
hygiene [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 [3]
- 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 [5]
- mandibular localization: 85% of cases [5]
- 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 extreme
size and with characteristic findings on imaging studies.
→ Differential diagnosis: fibrous dysplasia or histiocytosis
→ Therapy for giant ameloblastoma =>surgical resection [5]
→ Enucleation inadequate for large lesions ( high rate of recurrence ):
bony surgical margins of 1 to 2 cm recommended [6]
→ Caution should be exercised, however, because
histologic transformation can occur (both metastatic and
malignant 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 term
periodic follow-up which is very difficult in under- Fig 6a, 6b & 6c: postoperative aspect: without reconstruction
medicalized countries. Ameloblastoma implicates also ABSTRACT
diagnosis and therapeutic challenges in these countries.
REFERENCES The authors report a historical case of a recurrent giant
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