Unplanned immediate total mandibular reconstruction using a fibular osteocutaneous free flap after giant ameloblastoma eradication: A case report

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND | 2020. Ameloblastomas are the most common benign tumors that arise from odontogenic origins, and they are most often found at the jaw. Giant ameloblastomas require aggressive treatment that results in a large defect that requires reconstruction. Here, the authors report the case of a 41-year-old Thai woman with a giant ameloblastoma at her jaw that was managed in a single-stage procedure. The operation was scheduled urgently due to rapid tumor progression and the development of a bleeding ulcer at the tumor site. After the tumor was removed by total mandibulectomy, immediate mandibular reconstruction with a fibular osteocutaneous free flap was performed without prefabricated model. Previously reported proportions of the human mandible were used to guide the design of the fibular free flap for the neo-mandible. Masseter muscles and floor of mouth muscles were reattached at alternative locations. The final histopathologic examination revealed giant ameloblastoma (size 22×21×15 cm) with negative surgical margin, and no malignant change within the tumor was noted. The patient recovered with satisfactory appearance and function after the surgery. The present case highlights the challenges associated with unplanned immediate total mandibular reconstruction. The surgical steps highlighted in the present report may be of benefit to surgeons in limited resource settings that need to perform the present procedure urgently.