Adenomatoid odontogenic tumor in an unusual posterior maxillary location: a rare case report in a young male

Abstract

The adenomatoid odontogenic tumor is a rare benign epithelial odontogenic neoplasm that most frequently affects young women and typically occurs in the anterior maxilla. Its presentation in the posterior maxilla, especially in male patients, is uncommon and can create diagnostic challenges. This case describes a large posterior maxillary adenomatoid odontogenic tumor in a 16-year-old male who presented with a one-year history of progressive, painless swelling of the right cheek. Clinical examination revealed facial asymmetry, obliteration of the right nasolabial fold, and intraoral swelling extending from tooth 1.5 to the posterior maxilla. Panoramic radiography and computed tomography showed a multilocular radiolucent lesion with a "soap bubble" appearance, internal calcifications, and displacement of tooth 1.8 toward the floor of the right orbit, which remained intact. The lesion caused root resorption of adjacent teeth and extensive destruction of the maxillary bone. Surgical treatment consisted of enucleation and extraction of teeth 1.5-1.8, followed by histopathological confirmation of adenomatoid odontogenic tumor. Due to the degree of bone involvement, a subsequent wide resection of critical maxillofacial structures was necessary. Postoperative follow-up at five months showed no recurrence but significant residual anatomical changes. This case emphasizes the importance of including adenomatoid odontogenic tumor in the differential diagnosis of posterior maxillary lesions in male patients, and the need for careful surgical planning, histopathological confirmation, and long-term follow-up.

Keywords: adenomatoid odontogenic tumor; ameloblastoma; case reports; odontogenic tumor; oral surgical procedures.

Figure 1

Preoperative panoramic radiograph of the maxilla and mandible. Radiograph showing a multilocular radiolucent lesion with internal calcifications in the right hemimaxilla, involving teeth 1.5, 1.6, 1.7, and 1.8. The lesion causes displacement of the third molar (1.8) toward the floor of the right orbit, which remains intact. It exhibits a “soap bubble” appearance and well-defined borders.

Figure 2

Axial computed tomography images. (A) Preoperative scan showing a multilocular lesion in the right hemimaxilla with a “soap bubble” appearance and internal calcifications (outlined in green), involving teeth 1.5, 1.6, 1.7, and 1.8, and extending across the midline to involve the left maxilla. (B) Postoperative scan at 5-month follow-up demonstrating absence of the lesion and postoperative changes in the right maxillary region.