A case report of a huge unicystic ameloblastoma in the mandible with significant reduction through marsupialization.

Introduction: Marsupialization is a dependable choice for mandibular unicystic ameloblastoma (UA) management. However, investigations regarding its speed of shrinkage (SS) and reduction rate (RR) are lacking. This case report highlights the treatment of a huge mandibular UA with high SS and RR using marsupialization before secondary surgery.

Presentation Of Case: A 45-year-old male patient presented with severe swelling of the right side of the mandible, resulting in prominent facial asymmetry. Panoramic radiograph revealed a unilocular, radiolucent lesion extending from the mandibular midline to the right ramus. Computed tomography (CT) revealed a large radiolucent lesion that expanded in the buccolingual direction. Incisional biopsy showed that the lesion was UA. After 1.5 years of marsupialization, an SS of 0.183 % per day was reached, leading to an impressive RR of 98.7 %. Treatment was followed by enucleation and peripheral osteotomy. No recurrence was observed at 1 year post-surgery.

Discussion: The treatment of mandibular UA remains controversial, ranging from conservative approaches to aggressive interventions. In the current case, marsupialization was highly effective in reducing the volume of the lesion, thereby facilitating a minimally invasive secondary surgery to preserve function. The intact periosteum, which has the potential to differentiate into various cell types, may be associated with the regeneration of new bone after marsupialization.

Conclusion: Marsupialization remains a successful strategy for managing mandibular UA. Even the huge lesions causing facial deformity can be treated with marsupialization combined with secondary surgery, avoiding the aesthetic and functional disruptions associated with radical treatment.