Case presentation

A 46-year-old woman presented with a gradually enlarging swelling in the left temporal region of one year's duration (Figure 1). The swelling was non-tender, firm, and non-compressible. The patient had undergone a left hemimandibulectomy for ameloblastoma 16 years earlier and had remained asymptomatic during the intervening period.

Figure 1: Pre-operative clinical photograph of the patient presenting with temporal swellingThe patient presented with a gradually enlarging temporal swelling 16 years after surgical treatment (hemimandibulectomy) of mandibular ameloblastoma. (a) Frontal view demonstrating fullness in the left temporal region (green arrow). (b) Inferior view illustrating the contour deformity produced by the lesion (green arrow).

Clinical examination demonstrated a well-defined preauricular swelling with normal overlying skin. No facial nerve dysfunction, trismus, or significant limitation of mandibular movement was noted. Intraoral examination revealed satisfactory mouth opening and a stable occlusion.

Fine-needle aspiration cytology (FNAC) was inconclusive, showing predominantly lymphocytic inflammatory cells. Computed tomography revealed a soft-tissue lesion intimately associated with a bony structure resembling a remnant of the coronoid process (Figure 2).

Figure 2: Computed tomography of the face showing a space-occupying lesion in the left temporal regionAxial computed tomography images showing a well-defined space-occupying lesion in the temporal region (green arrow), closely associated with what appears to be a bony structure resembling the residual coronoid process. Radiographic findings raised a suspicion of recurrent pathology because of a history of hemimandibulectomy for ameloblastoma.

Surgical exploration under general anesthesia revealed a firm mass attached to the remnant of the coronoid process. En bloc excision of the lesion together with the associated bony fragment was performed (Figure 3).

Figure 3: Intraoperative findings and surgical management of recurrent ameloblastoma(a) Preoperative marking of the lesion in the left preauricular region (green arrow). (b) Intraoperative exposure of the lesion through a preauricular approach. The recurrent tumor mass is indicated by the green arrow (A, anterior; P, posterior; S, superior; I, inferior). (c) Excised specimen following en bloc resection. (d) Immediate postoperative view demonstrating wound closure.

Histopathological examination demonstrated nests and islands of odontogenic epithelium with peripheral palisading, reverse nuclear polarity, and central stellate reticulum-like areas, confirming the diagnosis of follicular ameloblastoma (Figure 4).

Figure 4: Histopathological features of recurrent follicular ameloblastomaOdontogenic epithelial islands exhibiting peripheral palisading of columnar ameloblast-like cells with reverse nuclear polarity and central stellate reticulum-like cells, consistent with the follicular variant of ameloblastoma (H&E stain, magnification 40X).

The postoperative course was uneventful. The patient was advised regarding the possibility of further recurrence and the importance of long-term follow-up. At the one-year review, no clinical or radiographic evidence of recurrence was identified (Figure 5).

Figure 5: One-year postoperative follow-up showing satisfactory healing without evidence of recurrence(a) Frontal view at the one-year follow-up demonstrating satisfactory facial symmetry and absence of clinically appreciable swelling in the left preauricular region. (b) Superior (bird’s-eye) view at the one-year follow-up showing a stable postoperative contour with no evidence of local recurrence. The postoperative course was uneventful, and the patient remained asymptomatic throughout the follow-up period.