Discussion

Although histologically benign, ameloblastoma is known for its locally aggressive behavior and high potential for recurrence [1,2], and the histopathological subtype, extent of disease, and adequacy of the initial surgical treatment influence recurrence rates. Conservative treatment approaches such as enucleation or curettage have consistently demonstrated higher recurrence rates than radical resection with appropriate margins [7,9]. Nakamura et al. have reported a recurrence rate of 33.3% among patients who received conservative management compared to 7.1% recurrence rates in the resection group [10]. In a more recent study, the conservative treatment group demonstrated a recurrence rate of 90.9% [11].

Delayed recurrence beyond 10 years is uncommon but well documented in the literature [4,5]. Such presentations are thought to result from microscopic residual disease that remains clinically silent for prolonged periods before demonstrating renewed growth. The present case is unusual because recurrence became evident 16 years after the initial surgery and presented primarily as a soft-tissue mass in the preauricular region.

The atypical location contributed to the diagnostic challenge. In addition, FNAC failed to establish a definitive diagnosis, yielding only inflammatory cellular elements. Similar limitations of cytological evaluation have been reported in odontogenic tumors, particularly when the sampled area does not contain representative epithelial tumor tissue [8].

The follicular histological pattern identified in the present case has historically been associated with a greater tendency toward recurrence than some other variants [3]. Complete surgical excision remains the cornerstone of treatment, while long-term clinical and radiological surveillance is essential because recurrence may occur many years after apparently successful therapy [4-6,8-12].

This case emphasizes the importance of maintaining a high index of suspicion when evaluating new preauricular or mandibular swellings in patients with a history of ameloblastoma, regardless of the interval since initial treatment.