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.