Extensive ameloblastic fibroma of the mandible in an elderly woman: A case report and review of the literature

Ameloblastic fibroma (AF) is a rare benign mixed tumor composed of odontogenic mesenchyme and epithelial tissue. AF typically develops in mandibular molars of young patients during childhood and adolescence, and rarely in adult. The primary treatment for AF is conservative enucleation of the tumor considering the patient's age and tumor size. However, mandibulectomy was performed for large and multilocular lesions. Computeraided surgery has recently become popular in the field of oral and maxillofacial surgery. Here, we report a rare case of extensive AF in an elderly woman, as well as a summary of their clinical features based on a review of 24 cases, which we successfully treated using a radical surgical approach of a computer-assisted surgery system. A 60-year-old woman presented with right posterior buccal gingival swelling in the mandible. Based on incisional biopsy results, the lesion was suspected to be caused by AF. With the assistance of virtual surgical planning, hemi-mandibulectomy was performed followed by immediate mandibular reconstruction with fibula osteocutaneous free flap and patient-specific titanium plate. The final diagnosis of AF was made based on the postoperative resection specimen. The patient's recovery period was uneventful. The patient returned to functional and aesthetic success, and a postoperative 3D-reconstructed computed tomography image revealed little clinical difference between the preoperative planning and postoperative results. This case demonstrates that a computer-aided surgery system can be an effective treatment option for the extensive AF radical approach. Longterm monitoring is required because AF has the potential for recurrence and malignant transformation, especially in adult.