Free fibula as a mode of reconstruction in large ameloblastomas of the mandible - An institutional experience.

[INTRODUCTION] Ameloblastoma is quite a rare, slow growing and locally invasive benign odon¬togenic tumour of epithelial origin with a high propensity to recur. Large tumours in the mandible can give rise to large defects after radical tumour resection with resultant impairment of form and function such as mastication, swallowing, speech as well as cosmesis due to asymmetry or abnormal projection. Therefore adequate mandibular reconstruction is of utmost importance. Immediate reconstruction after resection can be provided with the free fibula osteo-cutaneous flap amongst several other vascularised bone flaps.

[MATERIAL AND METHODS] We have found immediate reconstruction with fibula free flap to be a reliable option and report our experi¬ences and outcomes of radical surgical treatment of ameloblas¬toma, followed by immediate mandibular reconstruction with the same in this paper. All patients were followed up for a minimum of 3 years to a maximum of 5 years for outcome and recurrence.

[RESULTS] There were no flap loss reported. None of the patients required a second re-exploration surgery. 5 patients underwent subsequent prosthetic rehabilitation with dental implants.

[CONCLUSION] Large mandibular ameloblastomas should be treated radically with segmental mandibulectomy with a judicious surgical margin of at-least 1 cm from its radiographic margin as it has a high propensity to recur. The defects should be immediately reconstructed with a vascularised osteo-cutaneous flap to restore the pre-operative form function and cosmesis as far as possible. Postsurgical follow-up should be done at least annually for half a decade, as most cases recur within 5 years but some may show late recurrences as well.