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Segmental Mandibulectomy and Immediate Free Fibula Osteoseptocutaneous Flap Reconstruction with Endosteal Implants: An Ideal Treatment Method for Mandibular Ameloblastoma

Chana, Jagdeep S. M.D.; Chang, Yang-Ming D.D.S.; Wei, Fu-Chan M.D.; Shen, Yu-Fen D.D.S.; Chan, Chiu-Po D.D.S.; Lin, Hsiu-Na D.D.S.; Tsai, Chi-Ying D.D.S.; Jeng, Seng-Feng M.D.

Plastic & Reconstructive Surgery: January 2004 - Volume 113 - Issue 1 - pp 80-87
doi: 10.1097/01.PRS.0000097719.69616.29
Original Articles

Thirteen patients with large ameloblastomas of the mandible underwent segmental mandibulectomy and immediate reconstruction, with simultaneous placement of osseointegrated implants. All patients received palatal mucosal grafts around the dental implants 6 to 10 months after surgical treatment and received implant-supported prostheses another 1 to 2 months later. There were five female and eight male patients, with a mean age of 32 years (range, 17 to 50 years). The mean length of the mandibular defect was 8.8 cm (range, 5 to 13 cm). All free fibula flap procedures were successful, with no reexplorations or partial flap losses. There was no clinical or radiographic evidence of failure during the osseointegration process for any implant. With functional occlusal loading, the marginal bone loss around the implants was less than 1.5 mm in a mean follow-up period of 40 months (range, 18 to 70 months). There were no recurrences during that time. The technique described allows improved access to the bone at the time of reconstruction, immediate assessment of alveolar ridge relationships, and accurate fixation of the implant-fibula construct. The advantages of this procedure include a reduced risk of recurrence with segmental resection, reliable mandibular reconstruction, and reduction of the number of surgical procedures, allowing full oral rehabilitation in a shorter time. It is concluded that segmental mandibulectomy and immediate vascularized fibula osteoseptocutaneous flap reconstruction, with simultaneous placement of osseointegrated implants, represent an ideal treatment method for large ameloblastomas of the mandible.

Taipei, Taiwan

From the Departments of Oral and Maxillofacial Surgery, Plastic and Reconstructive Surgery, Dental Prosthetics, and Periodontal Medicine, Chang Gung Memorial Hospital.

Received for publication December 18, 2001;

revised March 17, 2003.

Fu-Chan Wei, M.D.

Department of Plastic and Reconstructive Surgery

Chang Gung Memorial Hospital

199 Tun Hwa North Road

Taipei 105, Taiwan

fcw2007@adm.cgmh.org.tw

©2004American Society of Plastic Surgeons