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LETTER TO EDITOR
Year : 2014  |  Volume : 3  |  Issue : 3  |  Page : 187-188

Giant anterior ameloblastoma managed by wide excision mandibulectomy with intraoral primary mucosal closure and skin defect coverage by deltopectoral flap


Department of Surgical Oncology, Meghjibhai Pethrajbhai Shah Cancer Hospital, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India

Date of Web Publication15-Jul-2014

Correspondence Address:
Abhishek Jain
Department of Surgical Oncology, Meghjibhai Pethrajbhai Shah Cancer Hospital, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-330X.136815

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How to cite this article:
Jain A, Gupta N, Shukla H, Tadaiya M. Giant anterior ameloblastoma managed by wide excision mandibulectomy with intraoral primary mucosal closure and skin defect coverage by deltopectoral flap. South Asian J Cancer 2014;3:187-8

How to cite this URL:
Jain A, Gupta N, Shukla H, Tadaiya M. Giant anterior ameloblastoma managed by wide excision mandibulectomy with intraoral primary mucosal closure and skin defect coverage by deltopectoral flap. South Asian J Cancer [serial online] 2014 [cited 2019 Aug 18];3:187-8. Available from: http://journal.sajc.org/text.asp?2014/3/3/187/136815

Dear Editor,

Odontogenic tumors comprise a complex group of lesions of diverse histopathological types and clinical behavior. Of all swellings of the oral cavity, 9% are odontogenic tumors and within this group, ameloblastoma accounts for 1% of lesions. [2] We report a case of giant anterior acanthotic variety of ameloblastoma in a 38-year-old male managed by surgery.

A 38-year-old patient came with the complain of gradually progressive painless swelling on lower jaw for 12 years [Figure 1]. There were skin ulcerations present over the swelling on the inferior aspect. A computed tomography (CT) scan with three-dimensional (3D) reconstruction was done, which showed multicystic expanding lesion 13 × 13 × 12 cm in size involving both the horizontal rami and central arch of mandible, with a typical "soap bubble" presentation. A trucut biopsy was consistent with ameloblastoma. Wide local excision of the tumor encompassing the part of both the ascending rami, horizontal rami, and the central arch was done. Primary intraoral mucosal closure was done. The external skin defect was covered by deltopectoral flap [Figure 2]. The deltopectoral flap was cut on the 22 nd postoperative day, and patient was discharged on 30 th postoperative day without any complications.
Figure 1: Patient presenting with a mandibular swelling

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Figure 2: Final appearance after closure and deltopectoral flap placement

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The average age of patients with ameloblastoma is 36 years. In developing countries, ameloblastomas occur in younger patients. Men and women are equally affected. The tumors appear to be larger in females. The ratio of ameloblastoma of the mandible to maxilla is five to one. Ameloblastomas of the mandible occur 12 years earlier than those of the maxilla. Ameloblastomas occur most frequently in the molar region of the mandible. [2] They are occasionally associated with unerupted third molar teeth. [1] The six different histopathological variants of ameloblastoma are desmoplastic, granular cell, basal cell, plexiform, follicular, and acanthomatous. [3] The acanthomatous variant is extremely rare. [4]

This study reports a case of giant acanthotic ameloblastoma that developed at the anterior mandible of a 38-year-old male. The term "giant" or "extreme" ameloblastoma is reserved for lesions that are truly large and that cause gross asymmetry and regional dysfunction. Patients with extreme ameloblastomas are usually from rural areas of developing countries who delay the treatment due to fear of surgery. [5]

Till date, there have been 11 reported cases of extreme ameloblastoma [Table 1]. The maximum size measured was 17 × 15 × 13 cm reported by Acharya et al., [5] whereas present case measured 15 × 14 × 15 cm. All reports were of large tumors involving half of the mandible, and histological diagnosis in these 11 cases was either follicular or plexiform type of ameloblastoma. [5] We report a case of acanthotic type of ameloblastoma, which is a rare entity.
Table 1: A review of clinical features, tumor size, and histopathological type of giant ameloblastomas that were previously reported and the present case

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  References Top

1.Ogunsalu C, Daisley H, Henry K, Bedayse S, White K, Jagdeo B, et al. A new radiological classification for ameloblastoma based on analysis of 19 cases. West Indian Med J 2006;55:434-9.  Back to cited text no. 1
    
2.Reichart PA, Philipsen HP, Sonner S. Ameloblastoma: Biological profile of 3677 cases. Eur J Cancer B Oral Oncol 1995;31B:86-99.  Back to cited text no. 2
    
3.Gruica B, Stauffer E, Buser D, Bornstein M. Ameloblastoma of the follicular, plexiform, and acanthomatous type in the maxillary sinus: A case report. Quintessence Int 2003;34:311-4.  Back to cited text no. 3
    
4.Walke VA, Munshi MM, Raut WK, Bobahate SK. Cytological diagnosis of acanthmatous ameloblastoma. J Cytol 2008;25:62.  Back to cited text no. 4
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5.Acharya S, Joshi A, Tayaar A, Gopalkrishnan K. Extreme ameloblastoma of the mandible with hypoproteinemia. A case report and review of clinicopathological features. J Clin Exp Dent 2011;3:e343-7.  Back to cited text no. 5
    


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