Unplanned Immediate Total Mandibular Reconstruction
Using a Fibular Osteocutaneous Free Flap after Giant
Ameloblastoma Eradication: A
Case Report:
Rushatamukayanunt P, MD, PhD, FRCST¹, Chaisrisawadisuk S, MD, FRCST²
Affiliation : ¹ Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ² Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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.
Received 30 Oct 2019 | Revised 27 Nov 2019 | Accepted 29 Nov 2019
Keywords : Immediate total mandibular reconstruction, Fibular osteocutaneous free flap, Giant ameloblastoma eradication,
Case report
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