A 20-year experience of immediate mandibular reconstruction using free fibula osteocutaneous flaps following ameloblastoma resection: Radical resection, outcomes, and recurrence

Abstract

BackgroundThe mandible is an important structure that is located in the lower third of the face. Large mandibular defects after tumor resection cause loss of its function. This study assessed the outcomes and tumor recurrence after immediate mandibular reconstruction using a free fibula osteocutaneous flap following radical resection of ameloblastoma.MethodsThis is a retrospective non-randomized study of outcomes and tumor recurrence of all patients diagnosed with mandibular ameloblastoma from August 1997 until August 2017 (20 years) requiring free fibula osteocutaneous flap reconstruction at a single institution. The patients were identified through an electronic operative database; subsequently, their medical records and photo documentation were retrieved.ResultsTwenty-seven patients were included in this study. Eighteen patients were male, while nine were female. The majority of the patients (48.1%) were in their third decade of life when they were diagnosed with ameloblastoma. All of them underwent radical resection of the tumor with a surgical margin of 2 cm (hemimandibulectomy in cases with a large tumor) and immediate mandibular reconstruction with a free fibula osteocutaneous flap. Two patients required revision of a vascular anastomosis due to venous thrombosis postoperatively, while one patient developed a flap recipient site infection. The flap success rate was 100%. There was no tumor recurrence during a mean follow-up period of 5.6 years.ConclusionsMandibular ameloblastoma should be treated with segmental mandibulectomy (with a surgical margin of 2 cm) to reduce the risk of recurrence. Subsequent mandibular and adjacent soft tissue defects should be reconstructed immediately with a free fibula osteocutaneous flap.

Additional treatment with Carnoy solution in surgical therapy of ameloblastomas: Case report

“…Because it is a unicystic ameloblastoma, it was chosen a conservative treatment, as is the case with enucleation. Because of the high rates of relapses consistent with the conservative treatment described in the literature (Chai et al, 2019), it was used carnoy's solution to provide a margin of safety, removing epithelial remnants that may promote recurrence of the lesion (Krishnapillai & Angadi 2010).…”

“…Ameloblastoma is a benign, slow-growing, locally invasive and expansive tumor, presenting high rates of relapse to surgical treatment (Aragão 2014;Effiom et al, 2018;Sheela et al, 2019;Saraiya 2020;Palanisamy & Jenzer 2020;González-González et al, 2020;Chai et al, 2019). It is an epithelial odontogenic tumor and its frequency is equal to that of all odontogenic tumors together, excluding odontomas (Fregnani et al, 2010;Palanisamy & Jenzer 2020;Kreppel & Zöller 2018).…”

“…Its predilection occurs in the mandible in 85% of cases and the posterior region, branch and mandibular angle are the most affected, comprising 75% of mandibular cases (Neville 2011; Palanisamy & Jenzer 2020; Chai et al, 2019). The tumor may occur at any age; however, there is predominance between the third and fifth decade of life (Effiom et al, 2018;Palanisamy & Jenzer 2020;Sheela et al, 2019;Chai et al, 2019). In the initial phase, ameloblastomas present scarce clinical features, without symptomatology, making the early diagnosis rare (Kruschewsky et al, 2010).…”

“…The surgical therapy of ameloblastoma can have several types of approach, from the most conservative to the most radical and the professional who will do the approach should choose the best treatment option (Carvalho et al, 2010;Neagu et al, 2019). Among the most conservative treatments are enucleation and marsupialization (Chai et al, 2019); among radicals resections are more widespread. The choice of therapeutic behavior depends on the size, type of lesion, location and histopathology (Palanisamy & Jenzer 2020).…”

“…The choice of therapeutic behavior depends on the size, type of lesion, location and histopathology (Palanisamy & Jenzer 2020). Radical interventions have a lower recurrence rate (Saraiya 2020), but most of them create aesthetic and functional damages that are difficult to reconstruct (Effiom et al, 2018;Chai et al, 2019). All extirpular surgical procedures aim at total removal of the lesion and elimination of remaining cells, so conservative treatments have a lower spectrum of action compared to radicals (Pogrel & Montes 2009).…”