Mandibular Ameloblastoma in a Four-Year-Old Child: Diagnostic Pitfalls and Long-Term Outcomes After Conservative Management

Abstract

Background: Paediatric ameloblastoma is a rare odontogenic tumour that may closely mimic benign cystic lesions, particularly dentigerous cysts, leading to diagnostic uncertainty. In young children, diagnostic evaluation may be limited because of age and reduced cooperation, which can increase the risk of misdiagnosis and inadequate treatment. Case Presentation: A four-year-old child presented with an asymptomatic unilocular radiolucent lesion in the mandible, initially diagnosed as a dentigerous cyst based on panoramic radiography. Because of the patient’s young age and limited cooperation, aspiration biopsy was not performed; instead, an excisional biopsy under general anaesthesia was planned to achieve both diagnosis and treatment in a single procedure. Advanced imaging methods, particularly cone beam computed tomography, were not obtained in order to minimise radiation exposure and due to the anticipated difficulty in maintaining a stable position during scanning. Intraoperatively, the lesion demonstrated atypical tissue characteristics and cancellous bone infiltration, prompting modification of the surgical plan to complete excision with peripheral osteotomy. Histopathological examination confirmed the diagnosis of conventional ameloblastoma. Postoperative healing was uneventful. During a three-year follow-up period, no clinical or radiological evidence of recurrence was observed. The eruption of the associated teeth progressed normally, and radiographs demonstrated satisfactory bone regeneration with preservation of mandibular growth. Conclusion: This case highlights the diagnostic challenges associated with radiolucent mandibular lesions in young children and emphasises the effect of diagnostic limitations related to age and cooperation on clinical decision making. Intraoperative findings may necessitate modification of the surgical strategy. Conservative excision combined with peripheral osteotomy can provide effective disease control while minimising morbidity in selected paediatric cases of conventional ameloblastoma.