Ten-year Evolution Utilizing Computer-Assisted Reconstruction for Giant Ameloblastoma

Abstract

Background The authors describe our current practice of computer-aided virtual planned and pre-executed surgeries using microvascular free tissue transfer with immediate placement of implants and dental prosthetics.

Methods All patients with ameloblastomas treated at New York University (NYU) Medical Center during a 10-year period from September 2001 to December 2011 were identified. Of the 38 (36 mandible/2 maxilla) patients that were treated in this time period, 20 were identified with advanced disease (giant ameloblastoma) requiring aggressive resection. Reconstruction of the resultant defects utilized microvascular free tissue transfer with an osseocutaneous fibular flap in all 20 of these patients.

Results Of the patients reconstructed with free vascularized tissue transfer, 35% (7/20) developed complications. There were two complete flap failures with consequent contralateral fibula flap placement. Sixteen patients to date have undergone placement of endosteal implants for complete dental rehabilitation, nine of which received immediate placement of the implants at the time of the free flap reconstruction. The three most recent patients received immediate placement of dental implants at the time of microvascular free tissue transfer as well as concurrent placement of dental prosthesis.

Conclusions To our knowledge, this patient cohort represents the largest series of comprehensive computer aided free-flap reconstruction with dental restoration for giant type ameloblastoma.

Keywords

ameloblastoma - mandible reconstruction - free fibula

• References

• 1 Macanovic M, Gangidi S, Porter G, Brown S, Courtney D, Porter J. Incidental bony pathology when reporting trauma orthopantomograms. Clin Radiol 2010; 65 (10) 842-849
• 2 Olaitan AA, Arole G, Adekeye EO. Recurrent ameloblastoma of the jaws. A follow-up study. Int J Oral Maxillofac Surg 1998; 27: 456-460
• 3 Wu Y-Q, Huang W, Zhang Z-Y, Zhang ZY, Zhang CP, Sun J. Clinical outcome of dental implants placed in fibula-free flaps for orofacial reconstruction. Chin Med J (Engl) 2008; 121: 1861-1865
• 4 Thankappan K, Trivedi NP, Subash P , et al. Three-dimensional computed tomography-based contouring of a free fibula bone graft for mandibular reconstruction. J Oral Maxillofac Surg 2008; 66: 2185-2192
• 5 Bähr W, Stoll P, Wächter R. Use of the “double barrel” free vascularized fibula in mandibular reconstruction. J Oral Maxillofac Surg 1998; 56: 38-44
• 6 Marchetti C, Bianchi A, Mazzoni S, Cipriani R, Campobassi A. Oromandibular reconstruction using a fibula osteocutaneous free flap: four different “preplating” techniques. Plast Reconstr Surg 2006; 118: 643-651
• 7 Ramesh RS, Manjunath S, Ustad TH, Pais S, Shivakumar K. Unicystic ameloblastoma of the mandible—an unusual case report and review of literature. Head Neck Oncol 2010; 2: 1
• 8 Rapidis AD, Andressakis DD, Stavrianos SD , et al. Ameloblastomas of the jaws: clinico-pathological review of 11 patients. Eur J Surg Oncol 2004; 30: 998-1002
• 9 Black CC, Addante RR, Mohila CA. Intraosseous ameloblastoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110: 585-592
• 10 Vanoven BJ, Parker NP, Petruzzelli GJ. Peripheral ameloblastoma of the maxilla: a case report and literature review. Am J Otolaryngol 2008; 29: 357-360
• 11 Dao TV, Bastidas JA, Kelsch R, Kraut RA. Malignant ameloblastoma: a case report of a recent onset of neck swelling in a patient with a previously treated ameloblastoma. J Oral Maxillofac Surg 2009; 67: 2685-2689
• 12 Reichart PA, Philipsen HP, Sonner S. Ameloblastoma: biological profile of 3677 cases. Eur J Cancer B Oral Oncol 1995; 31B: 86-99
• 13 Sham E, Leong J, Maher R, Schenberg M, Leung M, Mansour AK. Mandibular ameloblastoma: clinical experience and literature review. ANZ J Surg 2009; 79: 739-744
• 14 Adeline VL, Dimba EA, Wakoli KA , et al. Clinicopathologic features of ameloblastoma in Kenya: a 10-year audit. J Craniofac Surg 2008; 19: 1589-1593
• 15 Mendenhall WM, Werning JW, Fernandes R, Malyapa RS, Mendenhall NP. Ameloblastoma. Am J Clin Oncol 2007; 30: 645-648
• 16 Ghandhi D, Ayoub AF, Pogrel MA, MacDonald G, Brocklebank LM, Moos KF. Ameloblastoma: a surgeon's dilemma. J Oral Maxillofac Surg 2006; 64: 1010-1014
• 17 Pogrel MA, Podlesh S, Anthony JP, Alexander J. A comparison of vascularized and nonvascularized bone grafts for reconstruction of mandibular continuity defects. J Oral Maxillofac Surg 1997; 55: 1200-1206
• 18 Takushima A, Harii K, Asato H, Nakatsuka T, Kimata Y. Mandibular reconstruction using microvascular free flaps: a statistical analysis of 178 cases. Plast Reconstr Surg 2001; 108: 1555-1563
• 19 Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 1989; 84: 71-79
• 20 Lutz BS, Wei FC. Microsurgical workhorse flaps in head and neck reconstruction. Clin Plast Surg 2005; 32: 421-430 , vii
• 21 Kim EK, Evangelista M, Evans GR. Use of free tissue transfers in head and neck reconstruction. J Craniofac Surg 2008; 19: 1577-1582
• 22 Moro A, Cannas R, Boniello R, Gasparini G, Pelo S. Techniques on modeling the vascularized free fibula flap in mandibular reconstruction. J Craniofac Surg 2009; 20: 1571-1573
• 23 Cordeiro PG, Disa JJ, Hidalgo DA, Hu QY. Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients. Plast Reconstr Surg 1999; 104: 1314-1320
• 24 Peled M, El-Naaj IA, Lipin Y, Ardekian L. The use of free fibular flap for functional mandibular reconstruction. J Oral Maxillofac Surg 2005; 63: 220-224
• 25 Ndukwe KC, Adebiyi EK, Ugboko VI , et al. Ameloblastic carcinoma: a multicenter Nigerian study. J Oral Maxillofac Surg 2010; 68: 2111-2114
• 26 Darshani Gunawardhana KS, Jayasooriya PR, Rambukewela IK, Tilakaratne WM. A clinico-pathological comparison between mandibular and maxillary ameloblastomas in Sri Lanka. J Oral Pathol Med 2010; 39: 236-241