J Clin Exp Dent. 2010;2(3):e146-8.

Ameloblastoma of mandible.

Journal section: Oral Medicine and Pathology

Publication Types: Case report

doi:10.4317/jced.2.e146

Plexiform ameloblastoma of mandible - case report

Ajinkya Varkhede 1, JV Tupkari 2, MS Mandale 3, Manisha Sardar 4

P.G. student. Government Dental College & Hospital, Mumbai, Maharashtra, India.
Prof.& H.O.D., Government Dental College & Hospital, Mumbai, Maharashtra, India.
3 Asso. Prof, Government Dental College & Hospital, Mumbai, Maharashtra, India.
4. Senior Lecturer, Government Dental College & Hospital, Mumbai, Maharashtra, India.
1
2

Correspondence:
Dr. Ajinkya S Varkhede, PG student
Department of Oral Pathology and Microbiology
Room no 301, Government Dental College and Hospital,
Mumbai 400001 Maharashtra
Email address- varkhedeajinkya260@gmail.com

Received: 10/05/2010
Accepted: 18/06/2010

Varkhede A, Tupkari JV, Mandale MS, Sardar M. Plexiform ameloblastoma of mandible - case report. J Clin Exp Dent. 2010;2(3):e146-8.
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Article Number: 50306
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Abstract
Ameloblastoma, a benign epithelial odontogenic tumor, is locally aggressive. This tumor comprises about 1% of
tumors and cysts arising in the jaws. It appears most commonly in the third to fifth decades and with equal
frequen- cy between sexes. Ameloblastoma prevalently occurs in the mandibular molar and the ramus areas.
Recurrence frequently appears after inadequate treatment. They are usually benign in growth pattern but
frequently invade locally and occasionally metastasize. In the present study, a case of unusually large plexiform
ameloblastoma was presented with its clinical, radiological, histological features and treatment modalities, and
this is the addition of one more case in the literature.
Key words: Ameloblastoma, mandible, odontogenic tumors.
e1

Introduction
Ameloblastoma is a true neoplasm of odontogenic epithelium (1). It represents about 1% of all oral
ectodermal tumors and 9% of odontogenic tumors (2).
It is an ag- gressive neoplasm that arises from remnants
of the den- tal lamina and dental organ (odontogenic
epithelium) (3). Most ameloblastomas develop in the
molar-ramus region of the mandible with 70% of these
arising in the molar-ramus area and they are
occasionally associated with unerupted third molar
teeth (4). Ameloblastoma appears most commonly in
the third to fifth decades but the lesion can be found in
any age group including chil- dren (2, 5).
The chief histopathological variants of ameloblastoma
are the follicular and plexiform types, followed by the
acanthomatous and granular cell types. Uncommon variants include desmoplastic, basal cell, clear cell ameloblastoma, keratoameloblastoma and papilliferous ameloblastoma (5). It is well known that ameloblastoma
can be radiologically unilocular or multilocular
radiolucency with a honeycomb or soap bubble
appearance.
The plexiform pattern is less aggressive and has a
significantly lower recurrence rate (6).

Case report
A 12 year old girl had been reported to the Department
of Oral Pathology and Microbiology with complaint of
swelling on left side of face since last 2 years. The
medi- cal history was unremarkable.
Clinical examination revealed diffuse, smooth surfaced, hard swelling on left side of face. It extends from
the zygomatic region to the inferior border of mandible
superoinferiorly, and from the corner of mouth to the
angle of mandible anteroposteriorly. It was large, expansive, and painless. It was covered by normal
mucosa (Fig.1).

Intraorally, the swelling extends from distal of first molar posteriorly. Swelling results in obliteration of buccal
vestibule.
Panoramic radiography showed a large multilocular radiolucent area occupying the left mandible from the
first molar tooth to the neck of condylar process and the
co- ronoid process including the left ascending ramus
area. Root resorption was observed in the first molar.
The base of the mandible and the anterior border of the
ramus was damaged and thinned (Fig.2).

Fig. 2. Panoramic radiogram revealed a large multilocular radiolucent area extending from the left first molar to the left coronoid process including the left ascending ramus area. Permanent maxillary
and mandibular canines and premolars are seen below the deciduous
teeth.

The histopathological processing of the tumor revealed

a plexiform ameloblastoma predominantly composed
of epithelium arranged as a tangled network of anastomosing strands. The cords or sheets of epithelium are
bounded by columnar or cuboidal ameloblast like cells
surrounding more loosely arranged epithelial cells. The

Fig.1. A)Etra oral view shows swelling on left side of face; B) Intraoral view shows obliteration of left buccal vestibule

ramus and molar region of the mandible and it was not

associa- ted with a non-erupted tooth.
Ameloblastoma appears equal frequency between sexes,
although a higher frequency in females than in males has
been described (7). In our case, the patient was female

Fig.3. Anastomising cords of odontogenic epithelium

supporting stroma is loosely arranged and vascular

(Fig.3).
Under general anesthesia and nasoendotracheal intubation and all aseptic precautions, tumor mass was exposed buccally and lingually. After extraction of lower
first premolar, osteotomy cut was placed and completed buccally and lingually. Thus tumor mass was removed along with bone margin of 1.5 cm. Microvascular
free fibula graft was harvested from right leg along
with peroneal artery and vessels. Graft dimension was
14cmX3.5cmX3cm. Hemostasis was achieved, vacuum
drain was secured and closure was done in layers. Antibiotics, analgesics and anti-inflammatory drugs were
gi- ven postoperatively. Both wounds healed unevenly
and sutures were removed on 7th postoperative day.
Patient has been kept under periodic follow up since
then. No recurrence had been reported till date.

Discussion
Ameloblastoma is a benign epithelial odontogenic
tumor but is often aggressive and destructive, with the
capaci- ty to attain great size, erode bone and invade
adjacent structures (7). Although the term
ameloblastoma was co- ined by Churchill in 1933, the
first detailed description of this lesion was by Falkson
in 1879 (7). It is the most common odontogenic tumor
although it represents only about 1% of tumors and
cysts of the jaws (5).
In the mandible (80% of ameloblastomas), 70% are located in the area of the molars or the ascending ramus,
20% in the premolar region, and 10% in the anterior region (2). About 10-15% of ameloblastomas are associated with a non-erupted tooth. In the present case, a
large plexiform ameloblastoma found in the ascending

and was in second decade of her life.

Clinically, it frequently manifests as a painless
swelling, which can be accompanied by facial
deformity, maloc- clusion, ulceration and periodontal
disease and paresthe- sia of the affected area. In our
case, clinical examina- tion revealed a large,
expansive mass in the ascending ramus and molar
region of the mandible. The swelling was hard,
painless to palpation and covered by normal mucosa.
Histologically, ameloblastoma is characterized by the
proliferation of epithelial cells arranged in a
collagenous fibrous connective tissue stroma of
conjunctive vascu- lar tissue in locally invading
structures that resemble the enamel organ at different
stages of differentiation (7). The tumor found in our
patient was an ameloblastoma of the plexiform type.
The term plexiform refers to the appearance of
anastomosing islands of odontogenic epithelium in
contrast to a follicular pattern.

References
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7. Iordanidis S, Makos C, Dimitrakopoulos J, Kariki H. Ameloblastoma of the maxilla. Case report. Aust Dent J. 1999;44:51-5.