Pediatric Ameloblastic Fibroma: A Case Report

Abstract

Aim: To highlight the potential difficulties in diagnosing neoplastic lesion of the head and neck in children within autism spectrum. Background: Ameloblastic fibromas are a variation of odontogenic tumors that are located in the posterior mandible in 70% of cases. The tumors may be either unilocular or multilocular when observed radiographically. Ameloblastic fibromas tend to have well-defined, scalloped margins radiographically but may also be corticated. In close to 75% of all cases, an impacted tooth is associated with the lesion. Although not confined to patients who are in their first or second decades of life, ameloblastic fibromas most often arise in this population. Case description: A 9-year-old male diagnosed with autism presented with tenderness in the left mandible. The parents were able to elucidate the child's problem as tingling rather than pain. The patient was referred for histopathological diagnosis and treatment. After evaluation and biopsy, the lesion was identified as a pediatric ameloblastic fibroma. He subsequently underwent the conservative approach of marsupialization and curettage without complication. Six-month follow-up revealed no evidence of recurrence and normal eruption patterns of the succedaneous teeth in the affected area. Conclusion:In this specific case, the conservative approach to treatment appears to have been appropriate. This may not be the appropriate course for every case; as such, each case will have an individualized approach. Earlier recognition with careful inspection can reduce potential complications. Clinical significance: We might be missing early diagnosis of ameloblastic fibroma and other significant orofacial neoplasms in patients who are nonverbal or nondescriptive such as those with autism. Moreover, careful inspection of radiographic and clinical signs cannot be overemphasized.

Ameloblastic fibroma: a report of 4 clinical cases and review of the literature.

“…One patient underwent segmental mandible resection with 1 cm safe margin and IAN preservation 7 , and one patient underwent enucleation and received an iliac crest graft 8 . One patient 9 underwent marsupialization and curettage, with no recurrence. Three articles did not report follow up length, for the rest of publications, the mean follow up was 26,11 months (Range ).…”

“…However, Sanadi et al 7 performed a marginal resection with a safe 1cm margin and preservation of the IAN due to concerns about recurrence. Also, Whitson et al 9 performed marsupialization in their case, with posterior curettage and no recurrence in their 6-months follow up. In most articles, the mean follow-up was short (between 6-12 months) and only one article 11 reported a 12 year follow up.…”

“…Cases 2 and 3 presented with lesions in the posterior maxilla and cases 1 and 4 in the mandible (50 %) (symphysis and left posterior mandible). The mean age was 8,5 years (range [5][6][7][8][9][10][11][12][13]) and we found 2 male and 2 female patients. Mean follow up was 8,5 years (range 3-15 years).…”

Actualización en el Diagnóstico y Tratamiento del Fibroma Ameloblástico: Revisión Sistemática

“…En cuanto a los reportes que evaluaron el seguimiento y recidiva, ninguno de los estudios incluidos reportó recurrencia de la lesión tratada. ta en la zona premolar-molar (posterior) de la mandíbula (Atarbashi-Moghadam et al, 2019;Kumar et al, 2019;Whitson et al, 2020), seguido por el sector posterior del maxilar (Cutilli et al, 2019;Onda et al, 2021). Se han reportado además casos "poco comunes" en el seno maxilar (Carroll et al, 2019).…”

Pediatric Odontogenic Tumors

“…Generally, conservative resection is recommended for younger patients, while more radical approaches are applied to older patients or recurrent cases. 47 However, conservative excision, enucleation, or curettage of AF have been reported to result in recurrence rates exceeding 40%. 44 Extended long-term follow-up is recommended due to the high recurrence rate of ameloblastic fibromas and the potential for malignant transformation into ameloblastic fibrosarcomas.…”