medicina
Case Report
Ameloblastoma of the Mandible in a 16-Year-Old
Female—Case Report
Horatiu Urechescu 1 , Ancuta Banu 1, *, Flavia Baderca 2,3,4 , Raluca Maria Closca 2,4 , Maria-Bianca Ilas-Tat 4 ,
Florin Urtila 1 and Marius Pricop 1
Citation: Urechescu, H.; Banu, A.;
Baderca, F.; Closca, R.M.; Ilas-Tat,
M.-B.; Urtila, F.; Pricop, M.
Ameloblastoma of the Mandible in a
16-Year-Old Female—Case Report.
Medicina 2024, 60, 66. https://
doi.org/10.3390/medicina60010066
Academic Editor: Gaetano Isola
Received: 7 December 2023
Revised: 25 December 2023
Accepted: 27 December 2023
Published: 29 December 2023
Copyright: © 2023 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Medicina 2024, 60, 66. https://doi.org/10.3390/medicina60010066
1 Department of Oral and Maxillo-Facial Surgery, Faculty of Dental Medicine, “Victor Babes” University of
Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania;
urechescu.horatiu@umft.ro (H.U.); urtila.florin@umft.ro (F.U.); pricop.marius@umft.ro (M.P.)
2 Department of Microscopic Morphology, “Victor Babes” University of Medicine and Pharmacy Timisoara,
Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; baderca.flavia@umft.ro (F.B.);
raluca.moaca@umft.ro (R.M.C.)
3 Angiogenesis Research Center, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie
Murgu Square No. 2, 300041 Timisoara, Romania
4 Service of Pathology, Emergency City Hospital, 300254 Timisoara, Romania; drtatbianca0@gmail.com
* Correspondence: banu.ancuta@umft.ro; Tel.: +40-722273268
Abstract: Ameloblastoma is a benign epithelial tumor that has aggressive, destructive and unlimited
growth potential, having the capacity for recurrence and malignant transformation. Regarding the
symptoms and clinical signs, the presentation of ameloblastoma is poor. In children and young
people, ameloblastoma can be difficult to diagnose, because it mimics other benign lesions. Its
diagnosis requires a combination of imaging data, histopathological analysis and molecular tests. The
methods of treatment consist of radical surgery (segmental resection) and conservative treatments
(enucleation with bone curettage). The particularity of the presented case is represented by the late
request for medical consultation, a direct consequence of the measures implemented to prevent and
control the spread of COVID-19.
Keywords: ameloblastoma; mandible; COVID-19
1. Introduction
Ameloblastoma is a tumor whose terminology has been modified over time. Establish-
ing the nomenclature of ameloblastoma based on clinical and histological characteristics
and biological behavior is still a topic of interest among oral pathologists and molecular
biologists [1]. Ameloblastoma arises from remnants of the odontogenic epithelium, more
specifically the remnants of the dental lamina. Remnants situated outside the bone in the
soft tissues of the gingiva or alveolar mucosa may give rise to peripheral ameloblastoma.
Other possible sources of origin include the gingival surface epithelium and lining of
odontogenic cysts [2]. Genetic studies have made a significant contribution to updating
the types of ameloblastoma. The pathogenesis of ameloblastoma has been found to be
related to the deregulation of the SHH, WNT/β-catenin and MAPK signaling pathways,
and the detection of the BRAF V600E mutation has been found to be associated with more
aggressive clinical forms [3].
There are data in the literature that indicate LRP5, SLC6A3 and SOX10 are poten-
tially important genes whose presence is related to cell proliferation and invasion of
ameloblastomas, and a possible inhibitory treatment is indicated subject to clarification of
the molecular pathways of these genes in relation to ameloblastoma tumorigenesis [4].
Ameloblastoma classification has been narrowed to conventional ameloblastoma,
unicystic and extraosseous/peripheral types. The solid/multicystic type was eliminated
because most conventional ameloblastomas show cystic degeneration with no biological
https://www.mdpi.com/journal/medicina
Medicina 2024, 60, 66 2 of 8

differences. The desmoplastic type was left under the histopathological subtype (follicular,
plexiform, acanthomatous, granular cell, basaloid and desmoplastic) rather than as a sepa-
rate entity. Ameloblastic carcinoma is now classified under ameloblastic carcinomas due to
the morphologic continuum and similar behavior between these entities. Metastasizing
ameloblastoma has been moved to benign ameloblastoma subtypes from malignant odon-
togenic tumors (the main reason behind this change is attributed to the fact that primary
and metastatic ameloblastomas are histopathologically identical to benign ameloblastoma).
Odontoameloblastoma, which was used in the 2005 WHO classification, is no longer used
because the ameloblastic areas in the odontoma do not justify a separate entity [3].
A quick search of the literature highlights 67 case reports related to mandibular
ameloblastoma since 2017, when the classification of ameloblastoma was last updated. This
report highlights the fact that the patient delayed presentation to the doctor due to the
measures instituted at the national level during the COVID-19 pandemic. Although pain
and swelling are symptoms that normally cause patients to request an urgent consultation,
in this case, the patient decided to postpone the medical consultation until the restrictions
related to COVID-19 were lifted. During this time, the injury evolved, increasing asymme-
try. Another particularity of this case is the conservative treatment used, preserving the
continuity of the mandible.

2. Case Report
We present the case of a 16-year-old girl who presented to the Maxillofacial Surgery De-
partment complaining of swelling of the right perimandibular region for the last two years.
The particularity of this case is represented by the late request for medical consultation,
a direct consequence of the measures implemented to prevent and control the spread of
COVID-19, which, through restrictions implemented at the state level, complicated or even
blocked patients’ ability to acquire medical assistance other than that related to COVID-19.
Even after the elimination of restrictions, through the changes produced in the collective
mind, the means of limiting access to medical services persisted.
The facial examination (Figure 1) showed an asymmetry caused by a large diffuse
swelling located in the right mandibular region, hard in consistency and painless. The
skin overlying the swelling was stretched and was of normal color. The swelling started
spontaneously and gradually increased to its current size. There was no history of trauma
or dental pain. The patient was experiencing pain while chewing and did not have altered
sensation over the right lip region. The intraoral examination (Figure 2) revealed a swelling
in the right lower posterior buccal vestibule extending from the second premolar to the
retromolar region. The overlaying mucosa presented a superficial ulceration distal from
the second molar. The laboratory tests, consisting of a complete blood count and biochem-
ical and coagulation profiles, were all within normal limits. The only test that showed
increased values was ESR = 24 mm/h (0–10 mm/h). Also, the procalcitonin (PCT) value
was slightly increased at 0.41 (0.17–0.35/fL). This showed a degree of superinfection. The
interdisciplinary cardiological consultation, including the EKG, did not show any changes.
The chest X-ray showed no changes. No cervical ultrasound was performed, the cervical
ganglion system being clinically unchanged.
The patient underwent cone beam computed tomography (CBCT), which provides a
detailed 3D analysis of the dentition and cortical and medullary bone free of superimposi-
tions compared with classic radiographs like OPG. Compared with other cross-sectional
imaging modalities like spiral computed tomography or MRI, it is easily available, rela-
tively inexpensive and generally has a lower radiation dose. CBCT examination (Figure 3)
revealed a well-defined expansive radiolucency involving the right mandible, measuring
approximately 64 mm/25 mm/26 mm centimeters (sagittal/transversal/vertical). The
lesion spans in the sagittal plane from the periapical region of the first right mandibular
molar, involving the body, angle and ramus, to the sigmoid notch, vertically from the crest
of the mandibular ridge to the lower border of the mandible. Bucco-lingual expansion was
noted with extensive thinning of cortical plates and perforation of cortical plates. Displace-
Medicina 2024, 60, x FOR PEER REVIEW 3 of 9

Medicina 2024, 60, 66 3 of 8

mandibular ridge to the lower border of the mandible. Bucco-lingual expansion was noted
with extensive thinning of cortical plates and perforation of cortical plates. Displacement
ment of impacted
of impacted lower
lower rightright third
third molar
molar inferiorly
inferiorly into
into thelower
the lowerborder
borderof
of the
the mandibular
mandibular
angle was observed. Resorption of the roots of the first and second right mandibular
angle was observed. Resorption of the roots of the first and second right mandibular molars
mo-
was noted. The inferior alveolar nerve canal was displaced inferiorly.
lars was noted. The inferior alveolar nerve canal was displaced inferiorly.

Figure 1. The
Figure 1. The facial
facial examination.
examination. (A)
(A) Frontal
Frontal view;
view; (B)
(B) lateral
lateral right
right view.
view.

Medicina 2024, 60, x FOR PEER REVIEW 4 of 9

Figure 2.
Figure 2. Intraoral
Intraoral examination.
examination.

Figure 3. CBCT examination.

Figure 3. examination.(A)—axial
(A)—axialview,
view,(B)—coronal view,
(B)—coronal (C)—sagittal
view, view,
(C)—sagittal (D)—3D
view, reconstruction.
(D)—3D re-
construction.

The clinical and imagistic findings could have been suggestive of ameloblastoma, but
an odontogenic cyst could not be excluded. The main differential diagnosis that was con-
sidered was an odontogenic keratocyst. In this case, the risk of pathological fracture of the
Medicina 2024, 60, 66 4 of 8

The clinical and imagistic findings could have been suggestive of ameloblastoma,
but an odontogenic cyst could not be excluded. The main differential diagnosis that was
considered was an odontogenic keratocyst. In this case, the risk of pathological fracture
of the mandible is increased. It was decided that the patient should undergo emergency
surgery, which is why no preoperative biopsy was performed. The lesion was surgically
enucleated with curettage and extraction of the first and second right mandibular molars
and third impacted right mandibular molar under general anesthesia. The informed
consent for surgery was obtained from the patient’s mother.
The harvested specimens were fixed in 4% v/v buffered formaldehyde, sent to pathol-
ogy services and processed with the usual histological technique. Four-micrometer-thick
sections were cut using a semi-automated Leica RM2235 rotary microtome, displayed on
SuperFrost™ microscope (Fisherbrand, NH, USA) slides and stained with hematoxylin
and eosin.
Histopathological examination showed tumor proliferation with a follicular, plexiform
and solid (acanthomatous) pattern, with cyst formation. In a follicular pattern, islands of
odontogenic epithelium were interspersed within a stoma of mature collagenous connective
tissue. The islands had columnar cells at the periphery with reverse polarity and nuclei
oriented away from the basal membrane, and the central portion of the islands presented
loosely arranged epithelium cells that resemble the stellate reticulum of the developing
enamel organ. The plexiform pattern showed an odontogenic epithelium arranged in long
cords and stands that surrounded central areas of the supporting stroma. In addition to
the interconnecting epithelium stands and cords, islands and sheets of tumors cells were
observed. Also, the tumor showed areas of cystic degeneration, with the formation of micro-
or macrocysts. Some islands of tumor cells demonstrated central areas of squamous differ-
Medicina 2024, 60, x FOR PEER REVIEW
entiation, with the formation of keratotic pearls or individual keratinizations (Figures54–7).
of 9
There were no signs of malignant transformation and no immunohistochemical reactions.

Figure 4. Microscopic
Figure 4. Microscopic aspects
aspects of
of ameloblastoma
ameloblastoma and
and different
different growth
growth patterns:
patterns: (A)
(A) solid,
solid, (B)
(B) plexi-
plexi-
form, (C) macrocystic and (D) acanthomatous. HE staining, ob. 10
form, (C) macrocystic and (D) acanthomatous. HE staining, ob. 10×. × .
Medicina 2024, 60, 66 5 of 8
Figure 4. Microscopic aspects of ameloblastoma and different growth patterns: (A) solid, (B) plexi-
form, (C) macrocystic and (D) acanthomatous. HE staining, ob. 10×.

Figure 5. Histopathological
Figure 5. aspects of
Histopathological aspects of ameloblastoma:
ameloblastoma:(A,B)(A,B)plexiform
plexiformpattern,
pattern,with
withanastomosing
anastomosing
cords and
cords and trabeculae of odontogenic
odontogenic epithelial
epithelialcells
cellsscattered
scatteredininconnective
connectiveloose
loosetissue with
tissue withinflam-
inflam-
matory cells;
Medicina 2024, 60, x FOR PEER REVIEW
matory cells; (C)
(C) acanthomatous
acanthomatous pattern
patternwith
withsquamous
squamousmetaplasia
metaplasiaandandunicellular
unicellularkeratinization.
6 of 9
keratinization.
HE staining,
HE staining, ob.
ob. 10×.
10×.

Figure 6. Histopathological
Figure 6. aspects of
Histopathological aspects of ameloblastoma:
ameloblastoma:(A) (A)acanthomatous
acanthomatouspattern
patternwith
withsquamous
squamous
metaplasia and
metaplasia and unicellular keratinization;
keratinization;(B)
(B)follicular
folliculargrowth
growthpattern,
pattern,centrally
centrallystellate
stellatereticulum-
reticulum-
like;(C)
like; (C)acanthomatous
acanthomatouspattern
patternwith
withsquamous
squamousmetaplasia,
metaplasia,stellate
stellatecells
cellsand
andmicrocysts.
microcysts.HE HEstaining,
stain-
ing, ob.
ob. 20×. 20×.
 Figure 6. Histopathological aspects of ameloblastoma: (A) acanthomatous pattern with squa
metaplasia and unicellular keratinization; (B) follicular growth pattern, centrally stellate reticu
Medicina 2024, 60, 66 like; (C) acanthomatous pattern with squamous metaplasia, stellate cells and microcysts.
6 of 8 HE
ing, ob. 20×.

Figure
Figure 7. 7. Microscopic
Microscopic aspects
aspects of ameloblastoma–acanthomatous
of ameloblastoma–acanthomatous pattern
pattern with withmetaplasia,
squamous squamous metap
stellate
stellate cells
cells andand microcysts.
microcysts. HE staining,
HE staining, ob. 40×ob.
. 40×.

Short-term follow-up 4 months after surgery revealed a healed surgical site with
Short-term follow-up 4 months after surgery revealed a healed surgical site wit
no complaint of numbness of the right lower lip. Follow-up clinical and radiographic
complaint of
examination numbness
is essential of the right lower
as ameloblastoma lip. Follow-up
has a high clinical
recurrence rate. and radiographic
Depending on the e
ination isfindings,
follow-up essential as ameloblastoma
a wide-margin excisionhas
anda reconstruction
high recurrence canrate. Depending
be performed. on the fol
Also,
up findings,
prosthetic a wide-margin
rehabilitation is furtherexcision
planned and reconstruction
for the can
patient to correct besurgical
the performed.
defect Also,
and prost
missing teeth. is further planned for the patient to correct the surgical defect and mis
rehabilitation
3.teeth.
Discussion
Ameloblastoma is a benign epithelial tumor that constitutes about 14% of all jaw
3. Discussion
tumors and cysts. It has aggressive, destructive and unlimited growth potential, having the
Ameloblastoma
capacity is a benign
for recurrence, malignant epithelial tumor
transformation that constitutes
and metastasis about 14%
(in approximately 1% ofof all jaw
cases). There is no differentiation according to sex. The global incidence of ameloblastoma
mors and cysts. It has aggressive, destructive and unlimited growth potential, havin
is 0.5 cases/million people, with 10–15% of cases occurring in the pediatric population,
capacity for recurrence, malignant transformation and metastasis (in approximatel
reaching up to 25% in Africa and Asia [4].
Regarding intraosseous gnathic ameloblastoma (conventional and unicystic), ~80%
of cases occur in the mandible and ~20% cases occur in the maxilla [5]. Very rarely is it
reported in other head and neck sites like the sinonasal tract [6], middle ear [7], temporal
bone [8] and infratemporal fossa [9].
The maximum incidence depending on age varies as follows: conventional type
ameloblastoma, between 40 and 50 years; unicystic type ameloblastoma, between 20 and
30 years; and extraosal/peripheral type ameloblastoma, between 50 and 70 years [10].
Regarding the symptoms and clinical signs, the presentation of ameloblastoma is poor.
In some cases, a radiological change is occasionally detected on radiographs taken for
other reasons [11]. Painless swelling, with slow regional bone growth, is the most common
presenting symptom of ameloblastoma. Invasion of soft tissues, mobility of adjacent teeth
and dental malocclusion are other clinical signs. Pain is an unusual symptom that can occur
as a result of hemorrhage inside or adjacent to the tumor, or as a result of the invasion of
some nerve structures [12].
In children and young people, ameloblastoma can be difficult to diagnose, because
it mimics other benign lesions. Its diagnosis requires a combination of imaging data,
histopathological analysis and molecular tests. One example is the second most common
type of ameloblastoma, unicystic ameloblastoma. Located predilected in the posterior
mandibular area, it is clinically and radiologically similar to a dentigerous cyst due to its
association with impacted teeth [13]. One study has associated ameloblastoma with an
impacted tooth in 70% to 83% of cases [14].
The prognosis for ameloblastoma varies depending on age, type, location and size of
the formation, in direct relation to the degree of bone involvement, damage to adjacent
structures and type of surgical intervention (radical or conservative). All these influence
Medicina 2024, 60, 66 7 of 8

the recurrence rate of ameloblastoma, which is approximately 10% and can increase to
values between 55% and 90%, which complicates the patient’s clinical condition in the long
term [15,16]. The granular and follicular histological subtypes exhibit a higher recurrence
rate. Inadequately short follow-up periods may mislead physicians to falsely believe the
patient is cured, potentially leading to the oversight of metastatic ameloblastoma [17,18].
Radiologically, unicystic ameloblastoma has the following characteristics: unilocular
radiolucency, well-defined, corticated border, often associated with an impacted tooth,
specifically the mandibular third molar, possible root resorption and cortical perforation in
33% of cases.
According to some studies prior to 2020, ameloblastomas had an average size of
approximately 4 cm at presentation [19]. A meta-analysis shows an average ameloblastoma-
specific growth rate of 87.84% per year [20].
Regarding the presented case, its particularity is represented by the late request for
medical consultation, a direct consequence of the measures implemented to prevent and
control the spread of COVID-19. Coronavirus disease 2019 (COVID-19) was accompanied
by a series of measures that put pressure on health systems around the world. The available
medical assistance capacity was affected by the conversion of medical units into COVID-
19 care units [21], the deployment of doctors to care for patients with COVID-19, the
limitation of the number of hospitalizations by increasing the hospitalization time until
obtaining the result of the RT-PCR test and the decrease the degree of occupation of medical
departments by isolating patients. Other notable changes that affected patients included the
postponement of routine care, the use of telemedicine as a substitute for clinical consultation
with a negative impact on the quality of care, the restriction of the activity of dental offices,
triage activities [22]. Also, the fear of viral contagion produced a reluctance of patients to
request medical care [23]. It is reported in various medical studies that these changes have
led to diagnostic delays and poorer therapeutic results in a number of conditions [24–26].

4. Conclusions
Ameloblastoma is a benign epithelial tumor that has an aggressive, destructive, unlim-
ited growth potential, having the capacity for recurrence and malignant transformation.
The diagnosis requires a combination of imaging data and histopathological analysis to be
confirmed. The methods of treatment consisted of radical surgery (segmental resection)
and conservative treatments (enucleation with bone curettage). The particularity of the
presented case is represented by the late request for medical consultation, a direct conse-
quence of the measures implemented to prevent and control the spread of COVID-19, which
led to diagnostic delays and poorer therapeutic results. Periodic clinical and radiological
follow-up are mandatory due to the high recurrence rate of ameloblastoma.

Author Contributions: Conceptualization, H.U., M.P. and F.B.; methodology, A.B. and R.M.C.;
software, F.U. and M.-B.I.-T.; validation, H.U., M.P. and F.B.; formal analysis, A.B. and R.M.C.;
investigation, F.U. and M.-B.I.-T.; resources, F.U. and M.-B.I.-T.; data curation, F.U. and R.M.C.;
writing—original draft preparation, H.U. and F.B.; writing—review and editing, H.U. and M.P.;
visualization, H.U. and M.P.; supervision, H.U. and F.B.; project administration, M.P. and F.B. All
authors have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: The patient signed a written informed consent form, agreeing to the
publication of her medical data and any accompanying images.
Data Availability Statement: The data generated in this study may be requested from the corre-
sponding author.
Conflicts of Interest: The authors declare no conflict of interest.
Medicina 2024, 60, 66 8 of 8

References
1. Yoithapprabhunath, T.R.; Nirmal, R.M.; Ganapathy, N.; Mohanapriya, S.; Renugadevi, S.; Aravindhan, R.; Srichinthu, K.K.
Meta-terminology of Ameloblastoma. J. Pharm. Bioallied. Sci. 2019, 11, 140–145. [CrossRef] [PubMed]
2. Angadi, P. Head and Neck: Odontogenic tumor: Ameloblastoma. Atlas Genet. Cytogenet. Oncol. Haematol. 2011, 15, 223–229. [CrossRef]
3. Speight, P.; Takata, T. New tumour entities in the 4th edition of the World Health Organization Classification of Head and Neck
tumours: Odontogenic and maxillofacial bone tumours. Virchows Arch. 2017, 472, 331–339. [CrossRef] [PubMed]
4. Effiom, O.A.; Ogundana, O.M.; Akinshipo, A.O.; Akintoye, S.O. Ameloblastoma: Current etiopathological concepts and
management. Oral Dis. 2018, 24, 307–316. [CrossRef] [PubMed]
5. Vered, M.; Muller, S.; Heikinheimo, K. Ameloblastoma, Unicystic Type. In WHO Classification of Head and Neck Tumours, 4th ed.;
El-Naggar, A.K., Chan, J.K.C., Grandis, J.R., Takata, T., Slootweg, P.J., Eds.; IARC Press: Lyon, France, 2017; pp. 217–218.
6. Schafer, D.R.; Thompson, L.D.; Smith, B.C.; Wenig, B.M. Primary ameloblastoma of the sinonasal tract: A clinicopathologic study
of 24 cases. Cancer 1998, 82, 667–674. [CrossRef]
7. Yamatodani, T.; Misawa, K.; Endo, S.; Nakanishi, H.; Hosokawa, S.; Mineta, H. An Ameloblastoma in the Middle Ear. J. Int. Adv.
Otol. 2019, 15, 173–176. [CrossRef] [PubMed]
8. Košec, A.; Ajduk, J.; Ries, M.; Trotić, R. Primary Ameloblastoma of the Temporal Bone. J. Oral Maxillofac. Surg. 2017, 75,
1300.e1–1300.e4. [CrossRef] [PubMed]
9. Auluck, A.; Shetty, S.; Desai, R.; Mupparapu, M. Recurrent ameloblastoma of the infratemporal fossa: Diagnostic implications
and a review of the literature. Dentomaxillofac. Radiol. 2007, 36, 416–419. [CrossRef]
10. Wright, J.M.; Vered, M. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours:
Odontogenic and Maxillofacial Bone Tumors. Head Neck Pathol. 2017, 11, 68–77. [CrossRef]
11. Kreppel, M.; Zöller, J. Ameloblastoma—Clinical, radiological, and therapeutic findings. Oral Dis. 2018, 24, 63–66. [CrossRef]
12. Wright, J.M.; Soluk Tekkesin, M. Odontogenic tumors: Where are we in 2017? J. Istanb. Univ. Fac. Dent. 2017, 51, 10–30. [CrossRef]
[PubMed]
13. Bansal, S.; Desai, R.S.; Shirsat, P.; Prasad, P.; Karjodkar, F.; Andrade, N. The occurrence and pattern of ameloblastoma in children
and adolescents: An Indian institutional study of 41 years and review of the literature. Int. J. Oral Maxillofac. Surg. 2015, 44,
725–731. [CrossRef] [PubMed]
14. Robinson, L.; Martinez, M.G. Unicystic ameloblastoma: A prognostically distinct entity. Cancer 1977, 40, 2278–2285. [CrossRef] [PubMed]
15. Yang, R.; Liu, Z.; Gokavarapu, S.; Peng, C.; Cao, W.; Ji, T. Recurrence and cancerization of ameloblastoma: Multivariate analysis
of 87 recurrent craniofacial ameloblastoma to assess risk factors associated with early recurrence and secondary ameloblastic
carcinoma. Chin. J. Cancer Res. 2017, 29, 189–195. [CrossRef]
16. Laborde, A.; Nicot, R.; Wojcik, T.; Ferri, J.; Raoul, G. Ameloblastoma of the jaws: Management and recurrence rate. Eur. Ann.
Otorhinolaryngol. Head Neck Dis. 2017, 134, 7–11. [CrossRef]
17. Hong, J.; Yun, P.Y.; Chung, I.H.; Myoung, H.; Suh, J.D.; Seo, B.M.; Lee, J.H.; Choung, P.H. Long-term follow up on recurrence of
305 ameloblastoma cases. Int. J. Oral Maxillofac. Surg. 2007, 36, 283–288. [CrossRef]
18. Yilmaz, O.; Sagnak-Yilmaz, Z.; Balaban, E.; Candirli, C. Management of Recurrence of Ameloblastoma and Odontogenic
Keratocyst: A Cross-Sectional Study. Odovtos Int. J. Dent. Sci. 2020, 22, 174–186. [CrossRef]
19. Boffano, P.; Cavarra, F.; Tricarico, G.; Masu, L.; Brucoli, M.; Ruslin, M.; Forouzanfar, T.; Ridwan-Pramana, A.; Rodríguez-
Santamarta, T.; Ranz, M.R.; et al. The epidemiology and management of ameloblastomas: A European multicenter study.
J. Cranio-Maxillofac. Surg. 2021, 49, 1107–1112. [CrossRef]
20. Chae, M.P.; Smoll, N.R.; Hunter-Smith, D.J.; Rozen, W.M. Establishing the natural history and growth rate of ameloblastoma with
implications for management: Systematic review and meta-analysis. PLoS ONE 2015, 10, e0117241. [CrossRef]
21. D’Agostino, A.; Demartini, B.; Cavallotti, S.; Gambini, O. Mental health services in Italy during the COVID-19 outbreak. Lancet
Psychiatry 2020, 7, 385–387. [CrossRef]
22. Ren, Y.F.; Rasubala, L.; Malmstrom, H.; Eliav, E. Dental care and oral health under the clouds of COVID-19. JDR Clin. Trans. Res.
2020, 5, 202–210. [CrossRef] [PubMed]
23. Lazzerini, M.; Barbi, E.; Apicella, A.; Marchetti, F.; Cardinale, F.; Trobia, G. Delayed access or provision of care in Italy resulting
from fear of COVID-19. Lancet Child Adolesc. Health 2020, 4, 10–11. [CrossRef] [PubMed]
24. Aldujeli, A.; Hamadeh, A.; Briedis, K.; Tecson, K.M.; Rutland, J.; Krivickas, Z.; Stiklioraitis, S.; Briede, K.; Aldujeili, M.; Unikas,
R.; et al. Delays in presentation in patients with acute myocardial infarction during the COVID-19 pandemic. Cardiol. Res. 2020,
11, 386–391. [CrossRef] [PubMed]
25. Walker, L.E.; Heaton, H.A.; Monroe, R.J.; Reichard, R.R.; Kendall, M.; Mullan, A.F.; Goyal, D.G. Impact of the SARS-CoV-2
pandemic on emergency department presentations in an integrated health system. Mayo Clin. Proc. 2020, 95, 2395–2407. [CrossRef]
26. Ding, Y.Y.; Ramakrishna, S.; Long, A.H.; Phillips, C.A.; Montiel-Esparza, R.; Diorio, C.J.; Bailey, L.C.; Maude, S.L.; Aplenc, R.;
Batra, V.; et al. Delayed cancer diagnoses and high mortality in children during the COVID-19 pandemic. Pediatr. Blood Cancer
2020, 67, e28427. [CrossRef]

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