Ameloblastoma of the zygomatic region with infratemporal and orbital extension: a case report

Ameloblastoma is a slow-growing but locally invasive odontogenic tumor with a recognized tendency for recurrence despite its histologically benign appearance. Although most cases arise in the mandible, midfacial presentations with orbital or infratemporal extension are uncommon and may create substantial diagnostic, surgical, and reconstructive challenges. We report the case of a 63-year-old man who presented with a progressively enlarging right midfacial swelling centered over the zygomatic region, clinically apparent over the preceding 2-3 months. Computed tomography demonstrated a destructive mass centered in the right zygomatic bone, measuring approximately 6.5 × 4.5 × 6.0 cm, with extension into the zygomatic-orbital region and infratemporal fossa, while the maxilla appeared relatively preserved. Incisional biopsy favored ameloblastoma over adenomatoid odontogenic tumor, and definitive characterization was established after resection. The patient underwent en bloc tumor excision through a transfacial Weber-Ferguson approach, selected to provide adequate superior, lateral, and posterior exposure for margin-oriented resection of the orbital and infratemporal components. Reconstruction was performed using titanium mesh to restore the zygomatic-orbital contour, with buccal fat pad flap coverage. Final histopathology confirmed ameloblastoma with focal cystic change and tumor-free margins. Postoperative FDG PET/CT performed 1 month after surgery showed no residual local disease or distant metastasis. At 6-month clinical and radiologic follow-up, there was no evidence of recurrence, and the patient had no nasal obstruction, relevant phonation difficulty, diplopia, visual deterioration, or wound-related complications. This case illustrates an unusual zygomatic-orbital presentation of ameloblastoma with infratemporal extension and emphasizes the importance of detailed imaging, adequate surgical exposure, individualized reconstruction, and long-term surveillance.