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

Abstract

Ameloblastoma is the second most common odontogenic tumor of the oral cavity with the primary site being the mandible. The ratio of maxillomandibular involvement however is 5:1 in favor of the mandible. The most common complaint is a painless swelling over the mandibular area. Despite its benign nature, ameloblastoma has a high local recurrence rate, with the most recurrences seen within 5 years after operation. Biopsy and radiological evaluation may be helpful in differentiating the subtypes of ameloblastoma. Differentiation is important because some subtypes are more aggressive than the others. Preoperative planning may be done according to this classification, which can help decrease the recurrence rate. In our case, a 26-year-old female patient with recurrent ameloblastoma which developed on the fibular flap is presented. The free fibular flap and the left parasymphyseal part of the mandible were totally excised. Ameloblastoma was confirmed on pathological examination. We reconstructed the left mandibular site with a reconstruction plate and recurrence was not seen during follow up period.

Recurrent Ameloblastoma: A Surgical Challenge

“…Laborde et al and Becelli et al reported no recurrence in his study of 7 patients' postsegmental resection [ 41 , 8 ]. Similar reports are documented by Vayvada et al, Chaine et al, and Basat et al on postresection and free flap reconstruction [ 13 , 15 , 34 , 42 ].…”

“…Invasion of the periosteum can lead to spread of the tumour cells to the soft tissue. Inadequate resection of the hard and soft tissues beyond a tumour would cause recurrence [ 13 ].…”

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

“…It was related to inflammation, trauma and nutritional deficiencies. Yet, recent data strongly indicate that unique genetic abnormalities cause the development of ameloblastoma [1][2][3][4].…”

“…Ameloblastoma usually presents as a painless slowly growing tumour which can become a large and expansile swelling causing tooth loosening and displacement as well as facial asymmetry. CT scan is considered the gold standard for diagnosis [1,4,6]. Recurrence of ameloblastoma after surgical resection is not an uncommon event which reaches up to 15% even after adequate surgical resection.…”

Recurrence of ameloblastoma in an autogenous bone graft 10 years after initial operation: A case report and literature review

“…"solid/multicystic" was dropped because it has no biologic signi cance, but its clinical and radiographic features sometimes was unique [1]. Records in literatures [5][6][7][8][10][11][12][13][14][15][16][17][18][19][20][21][22][23] (table 1)among 25 patients which are about 10 patients graft bone CT showed multicystic [6-8, 12, 15, 18, 19, 21, 22]. Only 12 patients showed the pathological ndings, 6 showed acanthomatous ameloblastoma [5-8, 12, 17, 18, 21, 22].…”