Long‐term outcomes of mandibular reconstruction using non‐vascularised rib grafts following large ameloblastoma resection in Ethiopia

Abstract

Aim Ameloblastomas are odontogenic tumours that often require radical excision and mandibular reconstruction. This is challenging in resource‐limited settings where access to microsurgery is often scarce or absent. Currently, some patients are left without reconstruction, and others with bulky metal plates prone to complications. This leads to disfigurement and poor functional outcomes. We aim to establish robust long‐term outcomes for non‐vascularised autologous rib grafts for patients in this setting. Materials and Methods Twelve adult patients with large ameloblastomas underwent hemimandibulectomy and rib graft reconstruction during international surgical collaborations in Ethiopia between 2012 and 2015. A long‐term follow‐up was conducted in rural Ethiopia in February 2017. Results Follow‐up was possible for seven patients (58% of those treated). Mean post‐operative follow‐up time was 42.9 months (SD 11.7; range 24–60 months). Early complications were four superficial surgical site infections. Late complications were two cases of wire extrusion and one of keloid scarring. There were no graft failures. Patients reported reduced social stigma (p = 0.001) and pain (p = 0.03), excellent function and 100% satisfaction. Conclusion When situational factors preclude the use of microsurgery, bundle rib grafts offer a reliable alternative for total mandibular reconstruction for patients after ameloblastoma resection. Mild complications were experienced by most patients, but these were straightforward to manage and the rib grafts still took well, being surprisingly resistant to infection. Importantly, this technique is associated with long‐term improvements in social stigma and quality of life for patients.