Recurrent Ameloblastoma: Long Term Outcomes with Free Fibular Bone Graft
Ameloblastoma is a locally aggressive benign neoplasm of jaw that has high propensity to recur. Pathological subtype and intent of surgical excision during primary surgery are two factors that are known to affect the prognosis in these cases. Nevertheless, there are hardly any studies which have studied recurrent ameloblastoma cases. Apart from sharing a tertiary care cancer center’s experience in managing a series of recurrent ameloblastoma cases, we discuss some of the recent literature related to pathophysiology and principles related to their surgical management. Retrospective chart review of all those recurrent ameloblastoma cases which were operated between October 2013 and January 2016 and were subsequently followed up for minimum of 3 years. Total of 9 recurrent ameloblastoma cases were operated in the study period. All our patients had less—radical or non-curative intent surgical treatment in the past, and current treatment consisted wide excision of the involved segment of mandible with free fibular reconstruction. Among the 6 patients who were followed up for more than 3 years, none developed recurrence at 56.5 months of mean follow up duration. Almost all these patients had optimal results with good quality of life in terms of oral speech intellectuality and cosmetic perception of self. Complete excision of the involved segment of bone with reconstruction using the composite free fibular graft can provide optimal functional outcomes and can significantly lessen the chances of further recurrences.
KeywordsAmeloblastoma Recurrent ameloblastoma Free fibula graft Vascularized bone graft Dental implantation
This study was not funded by any agency.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
Since it was a retrospective study done on already available data, institute ethical committee approval was not obtained, however, departmental scientific and ethical committee has approved the study.
Informed consent was obtained from all individual participants included in the study.
- 11.Sammartino G, Zarrelli C, Urciuolo V, di Lauro AE, di Lauro F, Santarelli A et al (2007) Effectiveness of a new decisional algorithm in managing mandibular ameloblastomas: a 10-years experience. Br J Oral Maxillofac Surg 45:306–310. https://doi.org/10.1016/j.bjoms.2006.08.023 CrossRefPubMedGoogle Scholar
- 13.Slusarenko da Silva Y, Tartaroti NA, Sendyk DI, Deboni MCZ, Naclério-Homem MDG (2018) Is conservative surgery a better choice for the solid/multicystic ameloblastoma than radical surgery regarding recurrence? A systematic review. Oral Maxillofac Surg 22:349–356. https://doi.org/10.1007/s10006-018-0715-9 CrossRefPubMedGoogle Scholar
- 14.Antonoglou GN, Sándor GK (2015) Recurrence rates of intraosseous ameloblastomas of the jaws: a systematic review of conservative versus aggressive treatment approaches and meta-analysis of non-randomized studies. J Craniomaxillofac Surg 43:149–157. https://doi.org/10.1016/j.jcms.2014.10.027 CrossRefPubMedGoogle Scholar
- 15.Troiano G, Dioguardi M, Cocco A, Laino L, Cervino G, Cicciu M et al (2017) Conservative vs radical approach for the treatment of solid/multicystic ameloblastoma: a systematic review and meta-analysis of the last decade. Oral Health Prev Dent 15:421–426. https://doi.org/10.3290/j.ohpd.a38732 CrossRefPubMedGoogle Scholar
- 18.Hertog D, Schulten EAJM, Leemans CR, Winters HAH, Van der Waal I (2011) Management of recurrent ameloblastoma of the jaws; a 40-year single institution experience. Oral Oncol. 47:145–146. https://doi.org/10.1016/j.oraloncology.2010.11.008 CrossRefPubMedGoogle Scholar
- 24.Zemann W, Feichtinger M, Kowatsch E, Kärcher H (2007) Extensive ameloblastoma of the jaws: surgical management and immediate reconstruction using microvascular flaps. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103:190–196. https://doi.org/10.1016/j.tripleo.2006.05.004 CrossRefPubMedGoogle Scholar
- 26.Ooi A, Feng J, Tan HK, Ong YS (2014) Primary treatment of mandibular ameloblastoma with segmental resection and free fibula reconstruction: achieving satisfactory outcomes with low implant-prosthetic rehabilitation uptake. J Plast Reconstr Aesthet Surg 67:498–505. https://doi.org/10.1016/j.bjps.2014.01.005 CrossRefPubMedGoogle Scholar