Microvascular reconstruction with free fibula osteocutaneous flap in mandibular ameloblastomas—an institutional experience

Abstract

Background

Surgical resection is the mainstay for mandibular ameloblastomas. Optimal reconstruction and rehabilitation is important for a satisfactory outcome.

Methods

We retrospectively reviewed all cases of mandibular ameloblastoma who underwent resection and/or reconstruction at our institute over a period of 5 years and conducted an outcome survey. Our institutional protocol in such patients and results of the review are presented.

Results

Fifty-four cases were included in the study. Forty four cases had not undergone prior treatment, 8 underwent resection elsewhere while 2 were referred following recurrence after conservative resection. Fifty-five percent of the patients had a lateral segment defect and mean defect size was 7.4 cm. Only 13 cases underwent further dentoalveolar rehabilitation. We found that more than 90% patients were satisfied with respect to resolution of symptoms, speech, facial symmetry, walking, and overall improvement in social activity. Satisfaction regarding chewing (84%) and donor site appearance (77%) was lesser.

Conclusions

Segmental resection with adequate margins followed by reconstruction with free fibula flap is closest to the most ideal form of treatment available. Dentoalveolar rehabilitation is recommended in all such patients to improve final outcome.

Level of Evidence: Level IV, therapeutic study.

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