Treatment of ameloblastomas – Medicine outside the industrialized nations

Ameloblastomas are locally invasive tumors originating in ameloblasts, enamel-forming cells. It has different histological variants and a high recurrence rate. When the diagnosis is made in industrialized countries, it is usually an incidental finding, as the tumour often presents as a painless thickening of the jaw. The treatment of choice is complete resection with a safety margin. As part of a campaign by HNO für Kamerun in Ngaoundéré, a 9-year-old Cameroonian boy presented with a pronounced, invasive and displacing bone tumour of the lower right jaw. The clinical examination revealed a marked restriction of jaw mobility due to the size of the tumor, with almost complete inability to open the mouth. The massive growth of the bone tumor had already led to deformities of the mandible and, secondarily, of the maxilla. Clinical examination of the oral cavity is hardly possible. The pharynx is not affected by the tumor growth. The cCT/CT of the midface showed a clearly definable bone tumor of the right mandible with an extension of 12x9x12cm with displacing growth and displacement of the periodontal apparatus of the mandible and maxilla, without infiltration of the surrounding organs. A complete transmandibular resection of the tumor including mandible and temporomandibular joint on the right side in narcosis was performed. Reconstruction is only rarely advisable in cases of frequent malnutrition and prolonged surgery. This shows that, depending on access to medical care, even benign and easily treatable neoplasms can occur in severe form, with a significant reduction in quality of life and limited treatment options.