Odell Case – 2

1
A multilocular radiolucency
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 SUMMARY
2 A 45-year-old African man presents in the accident and emergency department with an enlarged jaw. You must
make a diagnosis and decide on treatment.
Complaint
The patient’s main complaint is that his lower back teeth on the right side are loose and that his jaw on the right
feels enlarged.
History of complaint
The patient has been aware of the teeth slowly becoming looser over the previous 6 months. They seem to be
‘moving’ and are now at a different height from his front teeth, making eating difficult. He is also concerned that
his jaw is enlarged and there seems to be reduced space for his tongue. He has recently had the lower second
molar on the right extracted. It was also loose but extraction does not seem to have cured the swelling. Although
not in pain, he has finally decided to seek treatment.
Medical history
He is otherwise fit and healthy

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 .
3
What are the red spots on the patient’s
tongue ?

Fungiform papillae. They appear more

prominent when the tongue is furred, as here,
for instance when the diet is not very abrasive

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 On the basis of what you know so far, what types of condition would you consider to be present?
4
History suggests
a slow growing
lesion hence,
more
likely to
be

Benign lesion

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5

History suggests no
malignancy
As there are
no features
suggesting
malignancy

Example –
perforation of the cortex,
ulceration of the mucosa,
numbness of the lip
devitalization of teeth,
lymph node enlargement

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 How to arrive at a differential diagnosis ?
6 - Commonest jaw lesions that cause ODONTOGENIC CYSTS
expansion are the odontogenic cysts

Odontogenic
Radicular cyst Dentigerous cyst
keratocyst

It is associated It is associated
They don’t usually
with a non-vital with unerupted
cause expansion
tooth tooth

In the above case

In the above
the tooth does not In the above case
case, expansion is
seem to be non- it is not seen
seen
vital

So we eliminate
Hence eliminated Hence eliminated
Radicular cyst
from the diagnosis from the diagnosis
from the diagnosis
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 Then what do we suspect?
7
ODONTOGENIC TUMOR

WHY?

It is common

It has higher prevalence in

Africans

Frequently encountered on the mentioned site.

Since the teeth are displaced and mobile, we
suspect AMELOBLASTOMA
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 What is your differential diagnosis?
8 - Ameloblastoma
Investigations
- Giant cell lesion

Would you do a Would you do an

Biopsy? aspiration biopsy

No, it is useful if
Yes, if
OKC is
Ameloblastoma
suspected

Whereas, if giant As it will be

cell lesion, then confirmed by
curattage aspirating keratin
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 Histological appearance interpretation
9

 The appearances are typical and diagnostic of ameloblastoma.

 The elongate basal cells bear a superficial resemblance to preameloblasts and the looser cells to
stellate reticulum.
 The arrangement of the epithelium in islands with the stellate reticulum in their centres constitutes the
follicular pattern of ameloblastoma

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 FINAL DIAGNOSIS -> AMELOBLASTOMA ->does the type matter? -> Yes for the treatment
10

TYPES

Solid multicystic Unicystic Desmoplastic Peripheral

A rare variant with A solid/multicystic

Seen with one cyst
sparse islands of ameloblastoma that
Conventional and cavity and no
ameloblastoma develops as a soft
most commonest separate islands of
dispersed in dense tissue nodule outside
tumour
fibrous tissue bone

Invades surrounding Does not Invades Invades surrounding Does not Invades
bone surrounding bone bone surrounding bone

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 1. The following lesions may appear radiographically as multilocular radiolucencies
11 EXCEPT
A. Ameloblastoma
B. Odontogenic myxoma
C. Radicular cyst
D. Odontogenic keratocyst

2. What other diagnostic investigation would you carry out for this patient?
A .CT Scan
B .MRI
C .Lateral cephalogram
D .PA view

3. What is the diagnosis according to clinical features and radiograph provided?

A. Dentigerous cyst
B. Unicystic Ameloblastoma
C. Multicystic Ameloblastoma
D. AOT

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 4. If the patient with Ameloblastoma had diapetes type 1, What will be the difficulty in the management
12 A. Poor healing
B. Infection
C. To control his glucose level before the surgery.
D. Intraoperative fracture

5. The most appropriate treatment for a unicystic ameloblastoma of the posterior mandible in an 18 year
old patient is
A. Root canal therapy.
B. Hemi-mandibulectomy.
C. Block resection.
D. Curettage.
E. Radiotherapy.

6. Tissue from multilocular radiolucent area of the posterior mandible histologically shows follicular areas
lined with columnar cells resembling the enamel organ, the diagnosis is
A. Neurofibroma
B. Ameloblastoma
C. Central fibroma
D. Lat periodontal cyst
E. Dentigerous cyst

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 Some clinical pictures –
13

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Thank you and best of luck !!!

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