PMC3981333_01
Preoperative external appearance of lower jaw swelling. (a) Frontal view. (b) Intraoral view showing tumor extending into sublingual region.
cp-2012-1-e30-g001.jpg
PMC3981333_01_cp-2012-1-e30-g001.jpg
F1
Overlying skin was freely mobile (Figure 1a). Intraorally, tumor was extending into sublingual region displacing tongue with loss of lower incisor and canine teeth (Figure 1b).
3D computed tomography revealing large expansile, multiseptate, lytic lesion involving (a) anterior portion of mandible. (b, c) tumor extension into left lateral part of the mandible.
cp-2012-1-e30-g002.jpg
PMC3981333_01_cp-2012-1-e30-g002.jpg
F2
A 3D CT scan revealed the presence of an expansive, multilocular, lytic lesion centered on the symphysis-menti (Figure 2a) and extending into parasymphyseal region and into the proximal body of the mandible on the left side (Figures 2b and 2c).
Autogenous osseomyocutaneous fibular flap (arrow) shaped into mandibular contour with reconstructive titanium plates (arrow head).
cp-2012-1-e30-g003.jpg
PMC3981333_01_cp-2012-1-e30-g003.jpg
F3
Specimen showing (a) tumor involving anterior and left lateral segment of the mandible and (b) cut section showing predominant solid component with few cystic areas.
cp-2012-1-e30-g004.jpg
PMC3981333_01_cp-2012-1-e30-g004.jpg
F4
(a) Histology showing basal layer with stellate reticulum like epithelium. (b) Tumor cells positive for cytokeratin 5 and 6.
cp-2012-1-e30-g005.jpg
PMC3981333_01_cp-2012-1-e30-g005.jpg
F5
Histology confirmed ameloblastoma with negative free margin (Figure 5a). Immunohistochemistry report revealed ameloblastoma positive for cytokeratin 5 and 6 (Figure 5b) and cytokeratin 14, negative for CD 68, cytokeratin 8 and 18 and calretinin.
Post-operative (a) X-ray revealing normal anatomical bone contour of the mandible supported by reconstructive plates and (b) anterior appearance of mandibular region on day 14 (good cosmesis). (c) Reconstructed Postoperative 3D CT scan (at 1 year follow up) revealing no local recurrence. Red arrows showing titanium reconstructive plates, (d) mandible with free fibular vascular flap.
cp-2012-1-e30-g006.jpg
PMC3981333_01_cp-2012-1-e30-g006.jpg
F6
Follow up x-rays showed almost normal contour of lower jaw (Figure 6a) and good cosmesis (Figure 6b) with normal jaw movements and normal healing bone graft. Patient is on follow up for 1 year with and 3D CT scan showed no local recurrence (Figures 6c and 6d).