Most likely diagnosis:

Ameloblastoma

Differential diagnosis: Odontogenic Keratocyst Dentigerous Cyst Central Giant Cell Granuloma Odontogenic Myxoma Aneurysmal Bone Cyst MANAGEMENT: History: 1. Demographics including name, age, sex, socioeconomic status, profession, residence etc 2. Presenting and chief complaint, information about lesion like When it was started How it was noticed Its progression if patient can provide any information Any associated symptoms like pain, difficulty in chewing due to mobility of adjacent teeth 3. Information about any previous investigations and treatment if taken 4. Any significant systemic history, drug history, past medical and surgical history, current medication in use Clinical Examination: if any clinical signs are present ETRAORAL: Site, size,tenderness, temp, consistency of lesion, overlying skin colour and texture, direction of expansion

Mental nerve paraesthesia rare in ameloblastoma Tmj movements can be disturbed in large lesions Any palpable lymph node in neck INTRAORAL: 1. 2. 3. 4. Site, size, tenderness, temperature,consistency of lesion if present clinically Status of overlying mucosa Mobility of adjacent teeth Cortical bone expansion( buccolingual is in ameloblastoma,anteroposterior in OKC) 5. Inferior alveolar nerve status 6. Any other significant finding if present ASPIRATION: To see any aspirate of clinical significance and microscopy like Cystic fluid in dentigrous cyst Cheesy material in odontogenic keratocyst Hemorrhagic aspirate in gaint cell lesion and aneurismal bone cyst In ameloblastoma usually there would be no aspirate RADIOGRAPHIC EVALUATION: Orthopentomogram is of choice As I know lesion appears as multilocular then I will notice Margins of lesion irregular in ameloblastoma and well defined in OKC Appearance soap bubble/honey comb significant of ameloblastoma Cortical expansion(buccolingual in ameloblastoma, anteroposterior in OKC Resorption of adjacent tooth roots more common in ameloblastoma than OKC

Other plane radiographs of face can help but are not of choice INCISIONAL BIOPSY: for definitive diagnosis and further management plan CT SCAN:To plan proper surgeryif biopsy proves ameloblastoma TREATMENT: there is only surgical treatment ranges from simple enucleation and curettage to en block resection for ameloblastoma Preop management: including all base line and any special investigation if required, consent, medication etc Perop management: plan will depend on clinical and all previous investigations I will go for marginal and segmental resection of mandible depending upon the size of lesion but definitively with clear margins of 1 to 1.5 cm clinically or clear margins with frozen sections. And if incional biopsy proves otherwise treatment will be according to that diagnosis e.g,in Odontogenic kertatocyst = enucleation and curettage / marginal resection Dentigrous cyst =enucleation / marsuplization Odontogenic myxoma = wide excision Gaint cell granuloma = excision and curettage Anurysmal bone cyst = curettage / enucleation RECONSTRUCTION: Will depend on the size of defect For small defect most suitable are non-vascularized iliac crest or costochondral graft For large defects I will go in stages

First reconstruction with recon rigid fixation plate, then after 2 to 3 months reconstruction with either composite pedicaled flap like clavical or composite free flaps of iliac crest or fibula. POSTOP MANAGEMENT: all necessary investigations and instructions FOLLOWUP: Regular follow up to see any recurrence or any other complication after 15 days, 1 month, 3 month then every year.