Ameloblastic Fibroma of Maxilla and Maxillary Sinus A Case Report

Ameloblastic fibroma is a rare mixed odontogenic tumor; accounts for 2.5% of odontogenic tumors [2,3]. It occurs primarily in young individuals (70% of patients are younger than the age of 20 years at presentation). There is no sexual or racial predilection [4-6]. Ameloblastic fibroma arises in the mandible in most of the cases (about 80%) with remainder arising in the maxilla [4,5,7,8]. Patients with ameloblastic fibroma usually complain of swelling of the jaw, failure of tooth eruption and /or pain [2,4]. Radiographically, AF appears radiolucent multilocular or unilocular cyst with difficulty in distinguishing it from simple ameloblastoma [2,4,7].


Introduction
Ameloblastic fibroma (AF) and related lesions are defined by WHO as neoplasms composed of proliferating odontogenic epithelium embedded in a cellular ectomesnchymal tissue resembling dental papilla and with varying degrees of inductive change and dental hard tissue formation [1].
Ameloblastic fibroma is a rare mixed odontogenic tumor; accounts for 2.5% of odontogenic tumors [2,3]. It occurs primarily in young individuals (70% of patients are younger than the age of 20 years at presentation). There is no sexual or racial predilection [4][5][6]. Ameloblastic fibroma arises in the mandible in most of the cases (about 80%) with remainder arising in the maxilla [4,5,7,8]. Patients with ameloblastic fibroma usually complain of swelling of the jaw, failure of tooth eruption and /or pain [2,4]. Radiographically, AF appears radiolucent multilocular or unilocular cyst with difficulty in distinguishing it from simple ameloblastoma [2,4,7].

Case Report
A 20 years old, married, Saudi female came to Oral & Maxillofacial Surgery Clinic of King Fahad Hospital-Hofuf, Saudi Arabia, complaining of pain which has started since few weeks around pointing teeth which failed to erupt in addition to swelling of the left side of the face. Swelling started five years earlier with gradual increase in size.
Medical History: Patient has no significant medical history.
Extra-oral examination showed asymmetrical expansion of left malar region and cheek. There was no ocular involvement and no regional lymphoadenopathy. Intra-oral examination showed swelling of left maxilla; expanding palatally, mesially and anterolaterally obliterating the upper left buccal sulcus from tooth # 23 to tooth # 27 region. Swelling was bony hard on all surfaces except the alveolar surface which is cystic in consistency with pointing multiple odontomes. Plain radiographs (orthopantomogram & occipitomental view) and Computerized Tomography (CT) showed well defined expansile mass within left maxilla and left maxillary sinus; with radiopaque dental tissues (odontomes) and displaced tooth # 28 (

Abstract
Ameloblastic fibroma (AF) is a rare mixed odontogenic tumor, It occurs mainly in young individuals with no sexual or racial predilection. It arises mainly in the mandible. The treatment of AF is controversial. Some authors recommend wide excision of the tumor, while others support enucleation or curettage initially with reserving modified block resection for recurrence. In this report, we present a case of ameloblastic fibroma of the maxilla and maxillary sinus which was treated by enucleation and curettage and has been followed up for more than two years without any evidence of residual tumor or recurrence.       The patient was followed up every three months for more than two years without any evidence of residual tumor or recurrence.

Discussion
Ameloblastic Fibroma is a mixed tumor. It consists of odontogenic ectomesenchyme resembling the dental papilla and epithelium resembling dental lamina and enamel organ without dental hard tissues [9]. It is slow growing tumor which can cause bone expansion [10]. The treatment of A.F is controversial. Some authors recommend wide excision of the tumor unless the extent of surgery will result in significant deformity, [11] On the other hand, others support enucleation or curettage initially; with reserving modified block resection in cases of recurrence [3,6,12].
In this case, enucleation and curettage were performed as a conservative treatment, with complete excision involving entire tumor, involved tooth and odontomes. The recurrence rate has been reported between 18.3 and 43.5% [4,11]. Patient has been on follow up for two years without any clinical or radiographical sign of residual or recurrent disease. On orthopantomogram, sign of bone remodeling is obvious (Figure 8).