title: Mandibular resection and reconstruction in the management of extensive ameloblastoma.
abstract: OBJECTIVE
  To present our experience with the management of 31 extensive mandibular ameloblastomas treated with segmental mandibulectomy, reconstruction with free fibula or iliac crest flap, and rehabilitation with immediate or delayed endosteal dental implants.
  
  
  METHODS
  The study sample comprised 31 patients with histologically confirmed mandibular ameloblastomas. Primary ameloblastomas were treated in 23 patients, and recurrent ameloblastomas affected 8 patients. Mandibular defect sizes ranged from 3.5 to 12.5 cm (mean, 5.6 cm). A free fibula osseous or osteocutaneous flap was used 17 times for reconstruction; in the remaining 14, a free iliac crest osseous or osteomuscular flap was chosen. Dental implants were positioned in 25 patients; implant procedures were performed simultaneously with reconstruction in 21 cases.
  
  
  RESULTS
  All flaps were transplanted successfully, and no major complication occurred postoperatively. Final histologic examinations showed 27 multicystic and 4 unicystic ameloblastomas. Free margins were achieved in all patients. The duration of follow-up was 18 to 120 months (mean, 53.6 months). No patient showed clinical or radiologic signs of recurrence. The dental implant success rate was 100%.
  
  
  CONCLUSIONS
  Segmental mandibular resection followed by immediate defect reconstruction with bone-containing free flaps with immediate dental implant placement should be considered as the treatment of choice for extensive mandibular ameloblastomas.
authors.affiliation: Maxillo Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Bianchi
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferri
authors.forename: Silvano
authors.initials: S
authors.lastname: Ferrari
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Leporati
authors.forename: Chiara
authors.initials: C
authors.lastname: Copelli
authors.forename: Teore
authors.initials: T
authors.lastname: Ferri
authors.forename: Enrico
authors.initials: E
authors.lastname: Sesenna
mesh_terms: D000328:Adult; D000368:Aged; D000564:Ameloblastoma / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery*; D016025:Bone Transplantation; D003758:Dental Implantation, Endosseous / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery*; D008875:Middle Aged; D008953:Models, Anatomic; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D055815:Young Adult