Vascularised fibula osteocutaneous flap for mandibular reconstruction and multiple implant retained fixed prosthetic rehabilitation of a patient with mandibular ameloblastoma

Abstract

Ameloblastomas are rare, benign dental tumours representing 1% of the oral tumours and cysts.1 The most common site for ameloblastoma is mandibular molar region. It is an aggressive benign tumour of epithelial origin that has generally been treated surgically for metastases. Treatment by wide excision is curative in up to 95% of cases. Chana et al2 proposed a 1–2 cm normal margin, and the large defect left after resection warrants reconstruction preferably with the fibula osteocutaneous flap. Taylor in 19753 first described vascularised fibula graft for composite reconstruction of the bone and soft tissue defect. After demonstrating that osteotomies can be performed in vascularised fibula grafts without compromising the viability of the bone segment, these grafts became the state of art reconstruction method after mandible ablation. The free fibula flap provides the greatest bone length and is suitable to accept dental implants. Osseointegrated implants have become generally accepted for prosthodontic management.4 The application of endosseous implants in combination with bone grafting for jaw reconstruction has allowed for improved results. Different types of osseointegrated implants have been placed either simultaneously with bone grafts5, 6 or at a later stage after the bone grafts have healed. In this case report a 23-year-old female patient underwent left hemimandibulectomy because of ameloblastoma. Fibula was osteotomised and reconstructed to resemble mandible shape and fixed to reconstruction plate with intact pedicle. Implants were placed four months after surgery and prosthetic rehabilitation of the edentulous site was accomplished.