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

Background The 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.

Methods This 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.

Results Twenty-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.

Conclusions Mandibular 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.

Keywords

Ameloblastoma - Mandibular reconstruction - Free tissue flaps

This article was presented at the 16th International Congress of OSAPS in conjunction with the ISAPS Symposium, and the 10th National Congress and 22nd Annual Scientific Meeting of InaPRAS, on July 21, 2018, in Bali, Indonesia.

Publication History

Received: 21 December 2018

Accepted: 23 August 2019

Article published online:
03 April 2022

• REFERENCES

• 1 Effiom OA, Ogundana OM, Akinshipo AO. et al. Ameloblastoma: current etiopathological concepts and management. Oral Dis 2018; 24: 307-16
• 2 McClary AC, West RB, McClary AC. et al. Ameloblastoma: a clinical review and trends in management. Eur Arch Otorhinolaryngol 2016; 273: 1649-61
• 3 Wang YY, Zhang HQ, Fan S. et al. Mandibular reconstruction with the vascularized fibula flap: comparison of virtual planning surgery and conventional surgery. Int J Oral Maxillofac Surg 2016; 45: 1400-5
• 4 Gbara A, Darwich K, Li L. et al. Long-term results of jaw reconstruction with microsurgical fibula grafts and dental implants. J Oral Maxillofac Surg 2007; 65: 1005-9
• 5 Brown JS, Lowe D, Kanatas A. et al. Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg 2017; 55: 113-26
• 6 Jewer DD, Boyd JB, Manktelow RT. et al. Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification. Plast Reconstr Surg 1989; 84: 391-403
• 7 Mohammad S, Malkunje LR. et al. Ameloblastoma of the anterior mandible. Natl J Maxillofac Surg 2014; 5: 47-50
• 8 Reichart PA, Philipsen HP, Sonner S. Ameloblastoma: biological profile of 3677 cases. Eur J Cancer B Oral Oncol 1995; 31B: 86-99
• 9 Ruslin M, Hendra FN, Vojdani A. et al. The epidemiology, treatment, and complication of ameloblastoma in East-Indonesia: 6 years retrospective study. Med Oral Patol Oral Cir Bucal 2018; 23: e54-8
• 10 Gopal KS, Swathi T, Mahesh P. Ameloblastoma: a case report with a systematic review on pathogenesis and recent trends in radiographic assessment. Sch J App Med Sci 2017; 5: 1396-402
• 11 Chana JS, Chang YM, Wei FC. et al. Segmental mandibulectomy and immediate free fibula osteoseptocutaneous flap reconstruction with endosteal implants: an ideal treatment method for mandibular ameloblastoma. Plast Reconstr Surg 2004; 113: 80-7
• 12 Hong J, Yun PY, Chung IH. et al. Long-term follow up on recurrence of 305 ameloblastoma cases. Int J Oral Maxillofac Surg 2007; 36: 283-8
• 13 Kaneko T, Nakamura S, Kawano R. et al. Peripheral ameloblastoma of the mandible: a case report. J Oral Maxillofac Surg Med Pathol 2016; 28: 565-8
• 14 Milman T, Ying GS, Pan W. et al. Ameloblastoma: 25 year experience at a single institution. Head Neck Pathol 2016; 10: 513-20
• 15 Rommel N, Kesting MR, Rohleder NH. et al. Mandible reconstruction with free fibula flaps: outcome of a cost-effective individual planning concept compared with virtual surgical planning. J Craniomaxillofac Surg 2017; 45: 1246-50
• 16 Lopez-Arcas JM, Arias J, Del Castillo JL. et al. The fibula osteomyocutaneous flap for mandible reconstruction: a 15-year experience. J Oral Maxillofac Surg 2010; 68: 2377-84
• 17 Peled M, El-Naaj IA, Lipin Y. et al. The use of free fibular flap for functional mandibular reconstruction. J Oral Maxillofac Surg 2005; 63: 220-4
• 18 Shpitzer T, Neligan PC, Gullane PJ. et al. The free iliac crest and fibula flaps in vascularized oromandibular reconstruction: comparison and long-term evaluation. Head Neck 1999; 21: 639-47
• 19 Munoz Guerra MF, Gias LN, Rodriguez Campo FJ. et al. Vascularized free fibular flap for mandibular reconstruction: a report of 26 cases. J Oral Maxillofac Surg 2001; 59: 140-4
• 20 Disa JJ, Hidalgo DA, Cordeiro PG. et al. Evaluation of bone height in osseous free flap mandible reconstruction: an indirect measure of bone mass. Plast Reconstr Surg 1999; 103: 1371-7
• 21 Foster RD, Anthony JP, Sharma A. et al. Vascularized bone flaps versus nonvascularized bone grafts for mandibular reconstruction: an outcome analysis of primary bony union and endosseous implant success. Head Neck 1999; 21: 66-71