Scully C. Oral and Maxillofacial Medicine.Edinburgh: Churchill Livingstone; 2013
Odell E, Cawson R. Cawson's Essentials of Oral Pathology and Oral Medicine, 9th edn. London: Elsevier; 2017
Soluk-Tekkeşin M, Wright JM. The World Health Organization classification of odontogenic lesions: a summary of the changes of the 2017 (4th) edition. Turk Patoloji Derg. 2018; 34 https://doi.org/10.5146/tjpath.2017.01410
Marx R, Stern D. Oral and Maxillofacial Pathology.Chicago: Quintessence; 2012
Nanci A. Ten Cate's Oral Histology Development, Structure and Function, 7th edn. St Louis, MO: Mosby; 2008
Glosser JW, Campbell JH. Pathologic change in soft tissues associated with radiographically ‘normal’ third molar impactions. Br J Oral Maxillofac Surg. 1999; 37:259-260 https://doi.org/10.1054/bjom.1999.0061
Edamatsu M, Kumamoto H, Ooya K, Echigo S. Apoptosis-related factors in the epithelial components of dental follicles and dentigerous cysts associated with impacted third molars of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 99:17-23 https://doi.org/10.1016/j.tripleo.2004.04.016
Eliasson S, Heimdahl A, Nordenram A. Pathological changes related to long-term impaction of third molars. A radiographic study. Int J Oral Maxillofac Surg. 1989; 18:210-212 https://doi.org/10.1016/s0901-5027(89)80055-4
Yildirim G, Ataoğlu H, Mihmanli A Pathologic changes in soft tissues associated with asymptomatic impacted third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106:14-18 https://doi.org/10.1016/j.tripleo.2007.11.021
Kotrashetti VS, Kale AD, Bhalaerao SS, Hallikeremath SR. Histopathologic changes in soft tissue associated with radiographically normal impacted third molars. Indian J Dent Res. 2010; 21:385-390 https://doi.org/10.4103/0970-9290.70809
Rakprasitkul S. Pathologic changes in the pericoronal tissues of unerupted third molars. Quintessence Int. 2001; 32:633-638
Mesgarzadeh AH, Esmailzadeh H, Abdolrahimi M, Shahamfar M. Pathosis associated with radiographically normal follicular tissues in third molar impactions: a clinicopathological study. Indian J Dent Res. 2008; 19:208-212 https://doi.org/10.4103/0970-9290.42952
Bhushan NS, Rao NM, Navatha M, Kumar BK. Ameloblastoma arising from a dentigerous cyst – a case report. J Clin Diagn Res. 2014; 8:ZD23-25 https://doi.org/10.7860/JCDR/2014/5944.4387
Deshmane S, Khot K. Unicystic ameloblastoma arising from a dentigerous cyst: a case report. Int J Oral Health Med Res. 2016; 3:38-40
Leitner C, Hoffmann J, Kröber S, Reinert S. Low-grade malignant fibrosarcoma of the dental follicle of an unerupted third molar without clinical evidence of any follicular lesion. J Craniomaxillofac Surg. 2007; 35:48-51 https://doi.org/10.1016/j.jcms.2006.11.005
Chae MP, Smoll NR, Hunter-Smith DJ, Rozen WM. Establishing the natural history and growth rate of ameloblastoma with implications for management: systematic review and meta-analysis. PLoS One. 2015; 10 https://doi.org/10.1371/journal.pone.0117241
Arakeri G, Rai KK, Shivakumar HR, Khaji SI. A massive dentigerous cyst of the mandible in a young patient: a case report. Plast Aesthet Res. 2015; 2:294-298 https://doi.org/10.4103/2347-9264.165439
Awasthi NP, Singh P. Clinico-pathological analysis of 68 cases of ameloblastoma – a retrospective study. J Adv Med Dent Scie Res. 2013; 1:79-81
Ramesh RS, Manjunath S, Ustad TH Unicystic ameloblastoma of the mandible – an unusual case report and review of literature. Head Neck Oncol. 2010; 2 https://doi.org/10.1186/1758-3284-2-1
Pogrel MA, Montes DM. Is there a role for enucleation in the management of ameloblastoma?. Int J Oral Maxillofac Surg. 2009; 807-812 https://doi.org/10.1016/j.ijom.2009.02.018
Rosenstein T, Pogrel MA, Smith RA, Regezi JA. Cystic ameloblastoma--behavior and treatment of 21 cases. J Oral Maxillofac Surg. 2001; 59:1311-1316 https://doi.org/10.1053/joms.2001.27522
Lebedev V, Butsan S. The use of Carnoy's solution and its modifications for reducing the number of recurrences after surgical removal of keratocystic odontogenic tumors and ameloblastomas: a systematic review. Moscow University Biological Sciences Bulletin. 2010; 74:108-116 https://doi.org/10.3103/S0096392519020068
Lee PK, Samman N, Ng IO. Unicystic ameloblastoma – use of Carnoy's solution after enucleation. Int J Oral Maxillofac Surg. 2004; 33:263-267 https://doi.org/10.1006/ijom.2003.0496
Sharma S, Kale T, Balihallimath L, M Kotrashetti S. Enucleation with peripheral ostectomy and chemical cauterization for unicystic ameloblastoma and odontogenic keratocyst: primary modality of choice or still a secondary alternative? A report of 18 cases. World J Dent. 2017; 8:467-470
Isacsson G, Andersson L, Forsslund H Diagnosis and treatment of the unicystic ameloblastoma. Int J Oral Maxillofac Surg. 1986; 15:759-764 https://doi.org/10.1016/s0300-9785(86)80119-3
Kim J, Nam E, Yoon S. Conservative management (marsupialization) of unicystic ameloblastoma: literature review and a case report. Maxillofac Plast Reconstr Surg. 2017; 39 https://doi.org/10.1186/s40902-017-0134-0
Lau SL, Samman N. Recurrence related to treatment modalities of unicystic ameloblastoma: a systematic review. Int J Oral Maxillofac Surg. 2006; 35:681-690 https://doi.org/10.1016/j.ijom.2006.02.016
Marker P, Brøndum N, Clausen PP, Bastian HL. Treatment of large odontogenic keratocysts by decompression and later cystectomy: a long-term follow-up and a histologic study of 23 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 82:122-131 https://doi.org/10.1016/s1079-2104(96)80214-9
Monitoring enlarged dental follicles: case report and literature review of an unusual presentation of a unicystic ameloblastoma Lily Long Jasveen Matharu Sunil Sah Dental Update 2024 48:7, 707-709.
Authors
LilyLong
BDS (Hons), MFDS
Dental Core Trainee, Department of Oral and Maxillofacial Surgery, Pinderfields Hospital, Wakefield
An ameloblastoma is a benign, yet locally aggressive odontogenic tumour. The vast majority (80%) of ameloblastomas arise in the mandible, and unicystic ameloblastomas are commonly found in relation to an unerupted lower third molar. We present the case of a 39-year-old patient with an incidental finding of an enlarged dental follicle around an unerupted lower third molar that progressed to an extensive unicystic ameloblastoma. This ameloblastoma was decompressed and marsupialized before enucleation to reduce the risk of pathological fracture due to the extensive size of the tumour.
CPD/Clinical Relevance: The case is relevant to general dental practitioners when considering monitoring dental follicles of unerupted teeth because the enlarged dental follicle described progressed to an extensive odontogenic tumour.
Article
An ameloblastoma is a benign, yet locally aggressive odontogenic tumour accounting for 1% of tumours and cysts affecting the jaws. The vast majority (80%) of ameloblastomas arise in the mandible.1,2 Unicystic ameloblastomas account for only 10% of all ameloblastomas and are most commonly found in relation to an unerupted lower third molar.3 The WHO described four types of ameloblastoma: conventional; unicystic; peripheral/extra-osseous; and metastasizing/malignant.4
There are three proposed mechanisms for the formation of a unicystic ameloblastoma: reduced enamel epithelium: cystic degeneration of a solid ameloblastoma; and those arising from a dentigerous cyst.1,5
Significant controversy surrounds the choice of treatment modality for ameloblastomas owing to their propensity to recur. Therapy ranges from radical en-bloc resection with 1–2 cm margins to conservative decompression, marsupialization and enucleation. We present a case of a large unicystic ameloblastoma of the mandible that arose from an enlarged dental follicle surrounding an unerupted lower third molar to highlight the importance of detecting and monitoring follicular changes in general dental practice.
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