Ameloblastic Fibroma of Posterior Maxilla: A Rare Entity

Background:Ameloblastic fibroma is an uncommon benign mixed odontogenic tumour composed of epithelial and ectomesenchymal elements. It usually affects younger patients and more frequently involves the posterior mandible than the maxilla. This report describes an adult patient with posterior maxillary involvement and a clinical suspicion of recurrent unicystic ameloblastoma. Case Presentation: A 30-year-old man presented with swelling and pain in the left upper posterior jaw approximately two years after surgery for unicystic ameloblastoma. Examination demonstrated a solitary swelling of the left posterior maxillary/alveolar region extending towards the palate, with focal erythema and ulceration. Radiographic examination revealed a well-defined, expansile, unilocular radiolucency involving the region of teeth 25–28, measuring approximately 35.49 mm superoinferiorly and 33.62 mm anteroposteriorly. Imaging showed cortical expansion, thinning and perforation, with extension towards the infraorbital floor, maxillary sinus, adjacent nasal cavity and oral cavity. Histopathological examination of submitted tissue fragments demonstrated cords, strands and islands of odontogenic epithelium within a hypercellular primitive ectomesenchymal stroma. Peripheral palisading, reverse polarity, stellate-reticulum-like cells and focal myxoid changes were also observed. The overall findings were suggestive of ameloblastic fibroma. Conclusion: This case illustrates the importance of correlating clinical and radiographic impressions with histopathological findings when assessing an unusual posterior maxillary lesion, particularly in a patient with a history of odontogenic tumour surgery.