Mandibular Reconstruction and Dental Implantation after Segmental Mandibulectomy of Ameloblastoma of the Mandible

하악골 법랑질모세포종의 분절 하악절제술 후 하악 재건 및 치아 임플란트 시술

  • Seo, Seung-Jo (Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine) ;
  • Lee, Il-Jae (Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine) ;
  • Lee, Jung-Geun (Department of Dentistry, Ajou University School of Medicine) ;
  • Lim, Hyo-Seob (Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine) ;
  • Kim, Chee-Sun (Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine) ;
  • Park, Myong-Chul (Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine)
  • 서승조 (아주대학교 의과대학 성형외과학교실) ;
  • 이일재 (아주대학교 의과대학 성형외과학교실) ;
  • 이정근 (아주대학교 의과대학 치과학교실) ;
  • 임효섭 (아주대학교 의과대학 성형외과학교실) ;
  • 김치선 (아주대학교 의과대학 성형외과학교실) ;
  • 박명철 (아주대학교 의과대학 성형외과학교실)
  • Received : 2010.11.28
  • Accepted : 2011.01.31
  • Published : 2011.03.10

Abstract

Purpose: Ameloblastomas are rare benign tumors of odontogenic origin, and compose about 1% of all oral and maxillomandibular cysts and tumors. Because this neoplasm has a high rate of local recurrence, segmental mandibulectomy with a 1~2 cm safety margin and immediate microsurgical reconstruction is an accepted treatment modality. The authors experienced four mandibular reconstruction cases that underwent secondary dental implantation. Here, the authors describe these cases and their long-term results. Methods: Four patients with ameloblastoma of the mandible underwent segmental mandibulectomy and reconstruction with a free fibula osseous flap from January 1999 to May 2005, followed by secondary dental implantation. Recurrence, bony union, implant osseointegration, and functional and aesthetic results were evaluated by radiologic imaging, by physical examination, and by using photographs. Results: All free flaps survived with no evidence of flap loss. To date, no recurrence has been noted clinically or radiologically. Imaging after mandibular reconstruction with a free fibular flap revealed satisfactory bony unions and mandibular contours. The patients achieved good aesthetic and functional results after the secondary implantation. Conclusion: Mandibular reconstruction using a fibular osseous flap and secondary dental implantation can produce good functional and aesthetic results after segmental mandibulectomy for ameloblastoma.

Keywords

References

  1. Regezi JA, Kerr DA, Countney RM: Odontogenic tumors: Analysis of 706 cases. J Oral Surg 36: 771, 1978
  2. Kameyama Y, Takehana S, Mizohata M, Nonobe K, Hara M, Kawai T, Fukaya M: A clinicopathological study of ameloblastoma. Int J Oral Maxillofac Surg 16: 706, 1987 https://doi.org/10.1016/S0901-5027(87)80057-7
  3. Ueno S, Mushimoto K, Shirasu R: Prognostic evaluation of ameloblastoma based on histologic and radiographic typing. J Oral Maxillofac Surg 47: 11, 1989
  4. Feinberg SE, Steinberg B: Surgical management of ameloblastoma: Current status of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 81: 383, 1996 https://doi.org/10.1016/S1079-2104(96)80012-6
  5. Chana JS, Chang YM, Wei FC, Shen YF, Chan CP, Lin HN, Tsai CY, Jeng SF: Segmental mandibulectomy and immediate free fibula osteoseptocutaneous flap reconstruction with endosteal implants: an ideal treatment method for mandibular ameloblastoma. Plast Reconstr Surg 113: 80, 2004 https://doi.org/10.1097/01.PRS.0000097719.69616.29
  6. Sand L, Jalouli J, Larsson PA, Magnusson B, Hirsch JM: Presence of human papilloma viruses in intraosseous ameloblastoma. J Oral Maxillofac Surg 58: 1129, 2000 https://doi.org/10.1053/joms.2000.9573
  7. Sehdev MK, Huvos AG, Strong EW, Gerold FP, Willis GW: Proceedings: ameloblastoma of maxilla and mandible. Cancer 33: 324, 1974 https://doi.org/10.1002/1097-0142(197402)33:2<324::AID-CNCR2820330205>3.0.CO;2-U
  8. Muller H, Slootweg PJ: The ameloblastoma, the controversial approach to therapy. J Maxillofac Surg 13: 79, 1985 https://doi.org/10.1016/S0301-0503(85)80021-7
  9. Shatkin S, Hoffmeister FS: Ameloblastoma: a rational approach to therapy. Oral Surg Oral Med Oral Pathol 20: 421, 1965 https://doi.org/10.1016/0030-4220(65)90231-8
  10. Mehlisch DR, Dahlin DC, Masson JK: Ameloblastoma: a clinicopathologic report. J Oral Surg 30: 9, 1972
  11. Carlson ER, Marx RE: The ameloblastoma: primary, curative surgical management. J Oral Maxillofac Surg 64: 484, 2006 https://doi.org/10.1016/j.joms.2005.11.032
  12. Hidalgo DA: Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 84: 71, 1989 https://doi.org/10.1097/00006534-198907000-00014
  13. Urken ML, Buchbinder D, Weinberg H, Vickery C, Sheiner A, Parker R, Schaefer J, Som P, Shapiro A, Lawson W, et al.: Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: a comparative study of reconstructed and nonreconstructed patients. Laryngoscope 101: 935, 1991
  14. Zlotolow IM, Huryn JM, Piro JD, Lenchewski E, Hidalgo DA: Osseointegrated implants and functional prosthetic rehabilitation in microvascular fibula free flap reconstructed mandibles. Am J Surg 164: 677, 1992 https://doi.org/10.1016/S0002-9610(05)80733-0
  15. Berggren A, Weiland AJ, Dorfman H: The effect of prolonged ischemia time on osteocyte and osteoblast survival in composite bone grafts revascularized by microvascular anastomoses. Plast Reconst Surg 69: 290, 1982 https://doi.org/10.1097/00006534-198202000-00019
  16. Hayter JP, Cawood JI: Oral rehabilitation with endosteal implants and free flaps. Int J Oral Maxillofac Surg 25: 3, 1996 https://doi.org/10.1016/S0901-5027(96)80004-X