Recurrent Ameloblastoma in the Free Fibula Flap: Review of Literature and an Unusual Case Report

Recurrence of ameloblastoma in bone grafts of a fibula free flap: A case report and literature review

Ameloblastoma is a benign odontogenic tumor with high recurrence rate. It can cause severe abnormalities of the face and jaw, leading to severe disfiguration and impaired jaw and airway functions. Wide local excision and reconstruction are required for ameloblastoma. Recurrence in the free bone graft is rare, especially in the fibula free flap. A 67-year-old man had a history of ameloblastoma of the left mandible resected 16 years ago with reconstruction using the fibula free flap. Three years ago, radiologic examination suggested a possible tumor recurrence in the fibula free flap. Because of the left facial swelling with hard, painless, and elastic tumor extending in the mandibular, he was admitted to the hospital and underwent segmental mandibulectomy. Ameloblastoma in the fibula was confirmed by pathological examination meanwhile not invasion in soft tissue nor bone margin. At the 24-month follow-up, no recurrence was detected. As the strong tendency for recurrence, especially in cases of large tumor size and soft tissue involvement, the radical resection and long-term follow-up are recommended.

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

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.

Recurrent mandibular ameloblastoma in soft tissue and rib graft 17 years after initial presentation

BACKGROUND

Ameloblastoma is the commonest odontogenic tumour of epithelial origin with a high incidence for developing local recurrence. We present a patient who developed local recurrence in both soft tissue and bone graft 17 years after the initial presentation.

CASE PRESENTATION

A 75-year-old female with a previous history of right hemimandibulectomy and rib reconstruction for ameloblastoma in 1999 presented to our centre with a large cystic mouth floor swelling, biopsy from which revealed recurrent ameloblastoma. The patient underwent excision of the recurrent mass en bloc with the cystic swelling through oral and cervical approaches. The patient was discharged after 5 days with an uneventful postoperative course and with a free 2-year follow-up from further recurrence.

CONCLUSION

Ameloblastoma is a locally aggressive tumour for which wide local excision with adequate margins is the best management approach. Recurrence of ameloblastoma even after adequate resection is not uncommon, and its management is considered a surgical challenge. A very long time may pass between the initial presentation and the development of recurrence.

Reconstruction of Deep Circumflex Iliac Artery Free Flap for Multiple Recurrent Ameloblastoma in Mandible

Ameloblastoma is the most common odontogenic tumor of epithelial origin. These tumors are benign in nature but have a high rate of recurrence and possible malignant development when treated inadequately. However, recurrent ameloblastomas in bone grafts are rare. This article presents a rare case of a multiple recurrent ameloblastoma, with the last recurrence in a nonvascularized free iliac bone graft of the mandible, reconstructed with vascularized deep circumflex iliac artery free flap for the surgical defect. Furthermore, an updated review of the literature on recurrent ameloblastomas affecting the bone graft is provided.

Recurrent Ameloblastoma: A Surgical Challenge

Ameloblastoma is locally aggressive benign odontogenic tumour with increased risk of recurrence rate. The choice of treatment depends on the histologic subtype. Radical therapy is the recommended modality for solid ameloblastomas. The possibilities of recurrence even after enbloc resection are still high. The author presents two case reports of recurrent ameloblastomas postradical resection. First case describes the recurrence of ameloblastoma in the bone graft which was used for reconstruction, and the second case depicts recurrence in the infratemporal fossa. Intraoperative radiography of the frozen section of the soft tissue margin plays an important role in the holistic management of these lesions.