A 17-year-old male patient was referred to the Maxillofacial Surgery Service of the University of Talca because of a lesion at the level of the right mandibular angle, revealed by a posterior lateral telegraph self-control.
The patient did not report any personal or family history.
The antecedents of tobacco, alcohol and drugs were negative, as well as the ingestion of drugs or allergies to them.
The general physical examination showed no compromise.
Extraoral clinical examination showed no aesthetic or functional alterations.
Intraoral fixation revealed a slight increase in volume in the posterior area of the mandibular vestibule.
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In the conventional radiological study, an extensive unilocular mixed density image was observed, with radiopaque predominance, surrounded by a radiolucent band of corticalized net limits located in the area of the piece 48, with partially projected roots.
The mandibular canal was displaced towards the basilar edge in the segment corresponding to the mandibular body and rejected distally in the ascending ramus.
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The study was complemented with a computerized axial tomography observing a hyperdense lesion, with net and corticalized limits, with widening of bone tables.
Its dimensions were: anterior-posterior 25.9 mm, in the palatal vestibule direction 21 mm and 28.3 mm of greater caudal cephalon diameter.
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Acquisition of images was achieved with both software package insertscan®, achieving axial compromise and panorex transversal compromise of the area of interest, through which closeness to the mandibular canal was confirmed.
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The differential diagnosis for this case was immature complex odontoma, ameloblastic fibroodontoma, calcifying epithelial odontogenic tumor and calcifying epithelial odontogenic cyst.
Once the radiological study was performed, an incisional biopsy was performed under local anesthesia, which included both hard and blade tissues and calcified dentinal tissue, with areas of lower calcification and fibrous connective tissue.
In the periphery fibrous connective tissue was observed and some small areas showed epithelium of odontogenic origin with presence of peripheral cilitic cells of the ameloblast type.
The sample was irregular and had no tooth structure.
According to this, the histological diagnosis was a lesion compatible with odontoma in the presence of changes to enamel formation.
The enucleation of the lesion was performed under general anesthesia through an extraoral approach at the level of the right mandibular angle to facilitate the modeling and subsequent placement of a rigid osteosynthesis.
This way, a very diminished vestibular table was attached to the affected area, which was removed to give way to the exposition and complete elimination of the lesion, concluding with a curettage of the surgical bed.
The remaining healthy bone tissue was very poor so it was planned to place a reconstruction plate 2.4 at the angle and mandibular body level to give greater resistance and avoid a pathological fracture.
The immediate graft was not planned due to the possibility of recurrence.
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Histopathological examination of the surgical specimen showed a greater amount of ameloblastic tissue, so the diagnosis of Ameloblastic Fibroodontoma was concluded.
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Healing did not occur.
Although this lesion has a low percentage of recurrence, the patient is regularly monitored and there have been no signs of it to date.
