Fibula Osteocutaneous Flap for Mandible Reconstruction after Ameloblastoma Resection: Amending Technique to Reduce Ischaemic Time

Ek Chee,T Sara Ahmad,Es Ng

doi:10.5704/moj.0705.010

Abstract

A 27-year-old patient with ameloblastoma of the mandible underwent anterior mandibulectomy and reconstruction with left fibula osteocutaneous flap. The bone was shaped at the lower limb before cutting the pedicle. Vascularised free fibula flap provides a good alternative to other bone grafts in mandible reconstruction as it is relatively easy to perform, carries a low complication rate, and mandibular shaping with intact pedicle cuts down on ischaemic as well as total operative time.

Highlights

Ameloblastoma, the most common odontogenic tumour, is locally invasive with a high rate of recurrence if not adequately removed
Ameloblastoma can grow to great size and cause facial asymmetry, displacement of teeth, loose teeth, malocclusion and pathological fracture
Chana et al 1 proposed a 1 to 2 cm normal margin, and the large defect left after resection warrants reconstruction preferably with the fibula osteocutaneous flap

Summary

INTRODUCTION

Ameloblastoma, the most common odontogenic tumour, is locally invasive with a high rate of recurrence if not adequately removed. Vascularised fibula graft was first described by Taylor in 1975 2, Later Chen and Yen incorporated an overlying skin paddle for composite reconstruction of the bone and soft tissue defect 3. After demonstrating that osteotomies can be performed in vascularised fibula grafts without compromising the viability of the bone segment, vascularised free fibula flap became the state of art reconstruction method after mandible ablation. The patient was well until 2006 when he again developed swelling over the same site, at which time he was diagnosed with recurrent ameloblastoma [Fig. 1]. A titanium miniplate with locking screws was used to secure the osteotomized fibula and the mandible [Fig. 2] This was carried out at the leg itself, with the pedicle intact. On day 9, a bone scan was performed to ensure uptake of the fibula graft [Fig. 3]. The patient was discharged with partial weight bearing for 6 weeks

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CONCLUSION