Mandibular Unicystic Ameloblastoma: Case Report with 23 Years of Follow-Up

Abstract

Unicystic ameloblastoma (UA) is a distinct clinicopathological variant of ameloblastoma that predominantly affects young patients and exhibits a wide range of histopathological patterns. The aim of this case report is to emphasize the importance of histopathological diagnosis and to present immediate mandibular reconstruction using a microvascular free fibula flap, with a 23-year follow-up. A 25-year-old man presented to the emergency department with a 24-hour history of pain and severe swelling in the left mandibular region that did not respond to painkillers. Clinical examination revealed swelling in the left retromolar area, tenderness on palpation, and absence of the left mandibular third molar. The patient reported that no third molar had ever been extracted. Periapical radiography revealed a large osteolytic lesion with displacement of the impacted third molar toward the inferior border of the mandible. Panoramic radiography and computed tomography confirmed an extensive osteolytic lesion involving the entire left mandibular ramus up to the condylar region. An incisional biopsy was performed, and histopathological examination confirmed unicystic ameloblastoma with mural nodules. The patient underwent left hemimandibulectomy followed by immediate reconstruction using a microvascular free fibula flap.