Giant ameloblastoma of the mandible

Introduction. Giant ameloblastomas are more common in developing countries. They raise a serious problem of management. We present the case of one of the largest ameloblastoma ever reported. Case report. A 48-year-old Congolese female patient was referred for mandibular swelling having begun 23 years before and now inducing severe functional disorders. A cephalic CT scan revealed a multicystic mass, 30 x 18 x 10 cm in size, with a typical "soap bubble" presentation, and with thinned and inflated cortical bone. The treatment was sub-total segmental mandibulectomy with immediate reconstruction using a fibular free flap, modeled on the sampling site by four ostectomies. The pathological examination confirmed the diagnosis of a benign follicular and plexiform ameloblastoma. The excess of soft tissue was treated with a right commissuroplasty on the 15th postoperative day. There was no complication. Discussion. Radical treatment followed by immediate reconstruction using a free flap is the treatment of choice for giant mandibular ameloblastomas, when considering immediate functional and esthetic benefits. This is a prime concern for patients with a difficult access to health care and for whom long-term follow-up is not feasible. (c) 2013 Published by Elsevier Masson SAS.