Surgical management of ameloblastoma in the mandible: Segmental mandibulectomy and immediate reconstruction with free fibula or deep circumflex iliac artery flap (evaluation of the long-term esthetic and functional results).
OBJECTIVE
Ameloblastoma is responsible for 1% of all the oral and maxillomandibular cysts and tumors. It is odontogenic in origin and benign in nature but it has a high percentage of local recurrence rate and possible malignant development when treated inadequately. With the advancement of craniofacial surgical techniques, use of free flaps for mandibular reconstruction, and dental rehabilitation (such as osseointegration), the segmental mandibulectomy and immediate reconstruction with free flaps are beginning to be used more effectively for the treatment of the mandibular ameloblastoma. The aim of this article is to evaluate the clinical results of the patients with mandibular ameloblastoma who were treated with segmental mandibulectomy and immediate reconstruction with free flaps.


METHODS
We present 11 patients who had segmental mandibulectomy and immediate reconstruction with free deep circumflex iliac artery or fibular flap for treatment of mandibular ameloblastoma. The average age of the patients was 25.4 years (range, 18-38 years). The patients were followed up for a mean of 29.3 months (range, 17-38 months). The functional and esthetic results were also evaluated by using a questionnaire in the long term. The questionnaire consisted of questions addressing oral continence, diet, social activities, speech, and facial appearance.


RESULTS
All flaps survived totally. Recurrence was not detected during the follow-up period. It was found that all patients had good esthetic and functional results after immediate reconstruction. The social activities of patients also were not affected after treatment.


CONCLUSIONS
We experienced that segmental mandibulectomy with safe borders and immediate reconstruction with free fibula flap or deep circumflex iliac artery (DCIA) flap is an ideal treatment method for mandibular ameloblastoma. The functional and esthetic results are also detected as very satisfactory for the patients.
Vayvada
Haluk
H
Department of Plastic and Reconstructive Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey. vayvada@ipras.net
Mola
Fahri
F
Menderes
Adnan
A
Yilmaz
Mustafa
M
D000293:Adolescent; D000328:Adult; D000564:Ameloblastoma / Q000601:surgery*; D016025:Bone Transplantation; D005260:Female; D005360:Fibula / Q000637:transplantation; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D008297:Male; D008334:Mandible / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery*; D019647:Oral Surgical Procedures; D010027:Osteotomy / Q000379:methods; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps / Q000098:blood supply; D011795:Surveys and Questionnaires; D016896:Treatment Outcome