Recurrent Ameloblastoma Involving Fibula Neo-mandible: Management with Digital Planning and Reconstruction Using a Contralateral Free Fibula Flap

Suzanne M Beecher,Paul Lennon,Conor P Barry,Michael O'Shaughnessy

doi:10.7759/cureus.7880

Abstract

Ameloblastoma is a locally aggressive tumor that most commonly arises in the mandible. It has a high rate of recurrence if inadequately excised. We report a case of a patient who developed recurrence of his ameloblastoma in his fibula flap mandibular reconstruction despite clear resection margins 23 years after resection. This is the first reported case of recurrent ameloblastoma in a neo-mandible reconstruction in the setting of negative margins. We discuss its surgical management using digital planning and reconstruction using a contralateral free fibula flap. Ameloblastoma is a locally aggressive entity that requires complete excision. Recurrence can even occur in the reconstruction, which can present a challenge to manage. Consideration should be given to repeat excision and second osseous flap reconstruction.

Highlights

Ameloblastomas are the most common odontogenic tumor of the jaws, with 80% of tumors occurring in the mandible [1]
We report a case of a patient who developed recurrence of his ameloblastoma in his fibula flap mandibular reconstruction despite clear resection margins 23 years after resection
We report a case of a patient who developed recurrence of his ameloblastoma in his fibula flap mandibular reconstruction despite clear resection margins and discuss its reconstruction

Summary

Introduction

Ameloblastomas are the most common odontogenic tumor of the jaws, with 80% of tumors occurring in the mandible [1]. We report a case of a patient who developed recurrence of his ameloblastoma in his fibula flap mandibular reconstruction despite clear resection margins and discuss its reconstruction. A 59-year-old man was referred to the Head and Neck Unit with swelling of the mucosa of his left mandible and exfoliation of his dental implants He had a history of previous segmental resection of the left mandible and free fibula flap reconstruction from the right lower leg for an ameloblastoma 23 years previously. How to cite this article Beecher S M, Lennon P, O'Shaughnessy M, et al (April 29, 2020) Recurrent Ameloblastoma Involving Fibula Neo-mandible: Management with Digital Planning and Reconstruction Using a Contralateral Free Fibula Flap. The patient proceeded to radical resection of the recurrent tumor with wide resection margins, but sparing the right mental nerve to preserve sensation of the contralateral lip and chin.

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