Ameloblastic Fibro-Odontoma of the Maxilla in a 4-Year-Old Girl: A Rare Paediatric Case

Abstract

Ameloblastic fibro-odontoma (AFO) is a rare mixed odontogenic lesion of childhood whose biological nature remains debated. Recent World Health Organization (WHO) classifications group most lesions previously diagnosed as AFO within the spectrum of developing odontomas rather than distinct odontogenic neoplasms. We report the case of a 4-year-old girl who presented with progressive left cheek swelling. Imaging revealed a well-circumscribed mixed radiolucent–radiopaque lesion of the anterior maxilla, associated with displacement of adjacent developing tooth germs. Complete surgical enucleation and curettage were performed, with removal of the closely associated developing tooth germs of teeth 22 and 23. Histopathological examination demonstrated a biphasic odontogenic proliferation composed of ameloblastoma-like epithelial cords and nests embedded in immature dental papilla–like ectomesenchymal stroma, with associated dentinoid and enamel matrix, consistent with AFO. At 2-year follow-up, there was no clinical evidence of recurrence. This case highlights the central role of integrated clinicoradiological and histopathological evaluation in the diagnosis of paediatric mixed odontogenic tumours. In the context of current WHO concepts, the expansile growth and classic biphasic architecture illustrate the continuing clinicopathological debate as to whether a subset of AFO-like lesions may represent true odontogenic neoplasms.