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The bony expansion, the location and the bony perforation are all typical clinical presentations for ameloblastomas in general, which could include a diagnosis of unicystic ameloblastoma. The age of the patient, however, is advanced compared to that in most cases of unicystic ameloblastoma. Furthermore, 90% of unicytic ameloblastomas present with impacted teeth simulating a dentigerous cyst, whereas the patient in this case does not have any impacted teeth. The histology in this case was not supportive of unicystic ameloblastoma.
Ameloblastomas are a family of neoplasms with varied clinical and radiographic presentation. Among these neoplasms, unicystic ameloblastoma would be the more likely diagnosis in this case if the unilocular radiolucency were taken into account as the most significant finding. However, neither the age of the patient nor the perforation of the jaw bone is supportive of a diagnosis of unicystic ameloblastoma. On the other hand, the age and bony perforation is a common presentation presentation for the conventional (solid, multicystic) ameloblastoma. The latter, however, tends to be radiographically multilocular rather than unilocular. In addition, 90% of unicystic ameloblastomas occur in association with an impacted tooth resembling a dentigerous cyst. As noted, the histology in this case was not supportive of any type of ameloblastoma. The patients with unicystic ameloblastomas are typically much younger, with an age range of 14-20 years.
Ameloblastoma, if not treated, can reach very large sizes, causing facial disfigurement. It loosens, displaces and resorbs adjacent teeth. Ameloblastomas are usually not painful unless infected, in which case they can be mildly painful. Parasthesia and anesthesia are extremely rare, unless the lesion is very large in size. Also, ameloblastoma tends to expand rather than perforate the cortical bone; if the latter occurs with extension into the adjacent soft tissue, it has a higher tendency for recurrence and therefore would have a worse prognosis than cases in which the ameloblastoma is completely encased by bone. The solid type is treated with en bloc or resection with clean margins. Curettage is the treatment of choice for the unicystic ameloblastoma.