gms | German Medical Science

Background: Various extirpative and reconstructive methods have been described for the treatment of large sized ameloblastomas. We describe our current practice of computer-aided virtual planned and pre-executed surgeries using microvascular free tissue transfer with immediate placement of implants and dental prosthetics.

Methods: All patients with ameloblastomas treated at NYU Medical Center during a 10-year period from September 2001 to December 2011 were identified. Of the 38 (36 mandible/2 maxilla) patients that were treated in this time period, 20 were identified with advanced disease (giant ameloblastoma) requiring aggressive resection. Reconstruction of the resultant defects utilized microvascular free tissue transfer with an osseo-cutaneous fibular flap in all 20 of these patients.

Results: Patients reconstructed with free vascularized tissue transfer suffered complications in 35% (7/20). These included neuropraxia, recipient site wound breakdown, and hematoma. There were two complete flap failures with consequent contra-lateral fibula flap placement. All patients ultimately healed their reconstructions well. Sixteen patients to date have undergone placement of endosteal implants for complete dental rehabilitation, nine of which received immediate placement of the implants at the time of the free flap reconstruction. The three most recent patients received immediate placement of dental implants at the time of microvascular free tissue transfer as well as concurrent placement of dental prosthesis, restoring full dental occlusion in one setting (Figure 1 [Fig. 1], Figure 2 [Fig. 2]).

Conclusions: To our knowledge, this patient cohort represents the largest series of comprehensive computer aided free-flap reconstruction with dental restoration for giant type ameoloblastoma.