PP147: Mandible reconstruction with fibular free flap after resection desmoplastic fibroma

Abstract

Introduction Desmoplastic fibroma is a rare benign tumor being rarely the cases described affecting to maxillary bones. It usually appears in childhood and adolescence age, Of unknown etiology, usually growth fast, producing a hemifacial asimetry and a limitation in many cases the oral aperture. Diagnostic imaging reveals an expansive and destructive bone lesion usually a large size. The definitive diagnosis is established for the histopathological study. Although it’s a benign clinical entity, due to its great capacity of local destruction and relapse, the treatment of choice is the aggressive surgery with subsequent reconstruction. The use of radiotherapy, is reserved to cases in which surgical excision is not possible. The follow-up of these patients must be long term. Case report 16-year-old man, who comes to consultation of maxillofacial surgery by a tumor at left hemifacial site of two months of evolution, progressive limitation of the oral opening and pain. In the Orthopantomography appears a large cystic lesion with destruction of the jaw body and branch ipsilateral with affection of the Temporomandibular joint (TMJ). The study with a three- dimensional scan showed a lesion which destruction of the mandibular branch, ATM and left zygomathic arch. After the biopsy of the lesion, the excision of the tumor was made, with mandibular zygomathic arch reconstruction in the same time using a fibular free flap, without any complications intra-postoperatory time. The histopathological diagnosis concluded that it was a jaw desmoplastic fibroma. The patient after two year of follow-up is disease-free. Conclusion Despite the benign nature of the Desmoplastic fibroma, due to his great aggressiveness and its high capacity of recurrence must carry out aggressive resection of the tumor. Other alternative treatments such as radiotherapy or chemotherapy should be taken into account, but due to the low incidence of this tumor pathology in the maxillofacial territory, there is no conclusive data regarding their effectiveness. New reconstructive techniques through microvascular free flaps, improving the aesthetic and functional results in our patients.