Discussion
Ameloblastoma is a locally aggressive benign tumor, with high rate of
recurrence (WHO, 2005) but rarely exhibits malignant behavior. This most
common odontogenic tumour was previously called adamantinoma and was
first identified by Cusack in 1827. It can grow to a very massive size,
exhibits high recurrence tendency and has been reported to recur even
more than 5 years after surgery, including recurrence in the bone graft
used in the reconstruction. 4,5,6
It occurs in individuals aged 20-40 years, but a unicystic type occurs
more frequently among the adolescent age group. The posterior aspect of
mandible is the most common location and the tumour shows no gender
predilection, though some authors have reported a higher female
incident. 7,8,9.
The management of ameloblastoma remains marginal or en bloc resection
with a margin of safety of 1-2cm, however, some histologic sub-types
have been shown to be less aggressive especially the unicystic variant
seen in younger age category. This unicystic type has been treated
conservatively in a number of cases often by enucleation with little
recurrence.
It has been noted that recurrent ameloblastomas can be diagnosed even
ten years after the first treatment hence need for long term follow up.8
The late presentation poses a serious challenge not only in terms
surgical resection of the extensive tumour but also reconstruction of
the continuity defect as well as functional rehabilitation. The use of
3D printed helps in highlighting the extent of the tumour as well as
appreciating the anticipated challenges that can be discussed with the
patient prior to obtaining consent. But what proved useful in this case
was the application of the generated 3D stereographic mirror image in
creating a near normal mandible that aided in accurate bending of the
reconstruction plate to achieve the pre-pathology normal anatomy.