Mandibular reconstruction with iliac crest graft for recurrent ameloblastoma: a case report

Karol Romero; Eduardo Ramos; Juan Marcos Parise-Vasco

Karol Romero Universidad Central del Ecuador. Posgrado de Cirugía Oral. Quito, Ecuador. https://orcid.org/0009-0009-9055-8625
Eduardo Ramos Hospital General Provincial Pablo Arturo Suarez, Quito, Ecuador. https://orcid.org/0009-0007-5794-436X
Juan Marcos Parise-Vasco Pontificia Universidad Católica del Ecuador. Facultad de Salud y Bienestar. Quito, Ecuador. https://orcid.org/0000-0002-5223-3370

Keywords: Ameloblastoma, Autologous transplant, Iliac crest, Mandibular reconstruction, Case report

Abstract

Background: Ameloblastoma is an odontogenic tumor characterized by slow but aggressive growth, which can lead to significant facial deformity and functional impairment.
Case Report: We present the case of a 47-year-old patient with a history of mandibular ameloblastoma treated with enucleation and curettage 20 years ago. The patient presented pain, paresthesia of the lower lip, and swelling in the mandibular region. Panoramic radiography and cone-beam computed tomography revealed a multilocular osteolytic lesion in the left hemimandible, suggesting tumor recurrence. An incisional biopsy confirmed the diagnosis of conventional ameloblastoma, plexiform variant. Due to the recurrent nature of the tumor, a radical approach was taken, consisting of block resection of the affected hemimandible followed by mandibular reconstruction using an autologous iliac crest graft. The surgery was meticulously planned using stereolithographic models, allowing precise adaptation of the graft. Postoperative follow-up showed positive results with complete healing and adequate functional recovery.
Conclusions: An accurate diagnosis is essential to determine the appropriate treatment for ameloblastoma, and thorough planning ensures a successful surgical outcome. The use of a free iliac crest graft offers several advantages, such as low morbidity at the donor site, availability of corticocancellous bone, and the ability to restore both function and aesthetics. Favorable results were achieved, significantly improving the patient's quality of life.

Downloads

Download data is not yet available.

References

1. Organización Mundial de la Salud. Consejo Editorial de la Clasificación de Tumores de la OMS. WHO Classification of Tumours, 5th edition head and neck tumours. 2022.
2. Shi HA, Ng CWB, Kwa CT, Sim QXC. Ameloblastoma: A succinct review of the classification, genetic understanding and novel molecular targeted therapies. Surgeon. 2021;19(4):238-243. https://doi.org/10.1016/j.surge.2020.06.009. Epub 2020 Jul 22. PMID: 32712102.
3. Bonitz L, Chhatwani S, Hassfeld S, Soemmer C, Bicsak A. Complex treatment of huge, massive growing ameloblastoma in teenage, a case re-port. Oral Maxillofac Surg Cases. 2021;7(3):100226. https://doi.org/10.1016/j.om sc.2021.100226
4. Carrasco Rueda CA, Vinitzky Brener I, Miranda Quijano TK, Fernández Morales EE, Aldape Barrios BC. Ameloblastoma Sólido: Revisión de La Lite-ratura y Reporte de Un Caso. Rev ADM. 2022; 79 (2): 103-108. https://doi.org/10.35366/104746.
5. Soluk-Tekkesin M, Wright JM. The World Health Organization Classification of Odontogenic Lesions: A Summary of the Changes of the 2022 (5th) Edition. Turk Patoloji Derg. 2022;38(2):168-184. https://doi.org/10.5146/tjpath.2022.01573. PMID: 35578902; PMCID: PMC9999699.
6. Goh YC, Siriwardena BSMS, Tilakaratne WM. Association of clinicopathological factors and treatment modalities in the recurrence of ameloblastoma: Analysis of 624 cases. J Oral Pathol Med. 2021 Oct;50(9):927-936. https://doi.org/10.1111/jop.13228. Epub 2021 Aug 16. PMID: 34358362.
7. Hendra FN, Van Cann EM, Helder MN, Ruslin M, de Visscher JG, Forouzanfar T, de Vet HCW. Global incidence and profile of ameloblastoma: A systematic review and meta-analysis. Oral Dis. 2020;26(1):12-21. https://doi.org/10.1111/odi. 13031. Epub 2019 Jan 25. PMID: 30614154.
8. Dhanuthai K, Chantarangsu S, Rojanawatsirivej S, Phattarataratip E, Darling M, Jackson-Boeters L, Said-Al-Naief N, Shin HI, An CH, Hong NT, An PH, Thosaporn W, Lam-ubol A, Subarnbhesaj A. Ameloblastoma: a multicentric study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(6):782-8. https://doi.org/10.1016/j.ooo o.2012.01.011. PMID: 22668706.
9. Hendra FN, Natsir Kalla DS, Van Cann EM, de Vet HCW, Helder MN, Forouzanfar T. Radical vs conservative treatment of intraosseous ameloblastoma: Systematic review and meta-analysis. Oral Dis. 2019;25(7):1683-1696. https://doi.org/10.1111/odi.13014. Epub 2019 Jan 1. PMID: 30548549.
10. Ghai S. Ameloblastoma: An Updated Narrative Review of an Enigmatic Tumor. Cureus. 2022; 14(8):e27734 https://doi.org/10.7759/cureus.277 34. PMID: 36127985; PMCID: PMC 481193.
11. Hendra FN, Helder MN, Ruslin M, Van Cann EM, Forouzanfar T. A network meta-analysis as-sessing the effectiveness of various radical and conservative surgical approaches regar-ding recurrence in treating solid/multicystic ameloblastomas. Sci Rep. 2023;13(1):8445. https: //doi.org/10.1038/s41598-023-32190-7. PMID: 372 31111; PMCID: PMC10213029.
12. Fariña R, Alister JP, Uribe F, Olate S, Arriagada A. Indications of Free Grafts in Mandibular Reconstruction, after Removing Benign Tumors: Treatment Algorithm. Plast Reconstr Surg Glob Open. 2016;4(8):e845. https://doi.org/10.1097/G OX.0000000000000832. PMID: 27622113; PMCID: PMC5010336.
13. Kademani D, Keller E. Iliac crest grafting for mandibular reconstruction. Atlas Oral Maxillofac Surg Clin North Am. 2006;14(2):161-70. https://doi.org/10.1016/j.cxom.2006.05.005. PMID: 16959603.
14. Bwambale P, Yahaya JJ, Owor G, Wabinga H. Histopathological patterns and biological characteristics of ameloblastoma: A retrospective cross-sectional study. J Taibah Univ Med Sci. 2021;17(1):96-104. https://doi.org/10.1016/j.jtumed.2021.09.007. PMID: 35140571; PMCID: PM C8801468.
15. Hresko A, Palyvoda R, Burtyn O, Chepurnyi Y, Kopchak A, Helder M, Forouzanfar T. Recurrent Ameloblastoma: Clinical Manifestation and Disease-Free Survival Rate. J Oncol. 2022;2022:2148086. https://doi.org/10.1155/2022/2148086. PMID: 359 83087; PMCID: PMC9381261.
16. Laborde A, Nicot R, Wojcik T, Ferri J, Raoul G. Ameloblastoma of the jaws: Management and recurrence rate. Eur Ann Otorhinolaryngol Head Neck Dis. 2017;134(1):7-11. https://doi.org/10.1016/j.anorl.2016.09.004. Epub 2016 Oct 25. PMID: 27793625.
17. Ledesma-Montes C, Mosqueda-Taylor A, Carlos-Bregni R, de León ER, Palma-Guzmán JM, Páez-Valencia C, Meneses-García A. Ameloblastomas: a regional Latin-American multicentric study. Oral Dis. 2007;13(3):303-7. https://doi.org/10.1111/j.1601-0825.2006.01284.x. PMID: 17448213.
18. Paré A, Bossard A, Laure B, Weiss P, Gauthier O, Corre P. Reconstruction of segmental mandibular defects: Current procedures and perspectives. Laryngoscope Investig Otolaryngol. 2019 Nov 22;4(6):587-596. https://doi.org/10.1002/lio2.325. PMID: 31890875; PMCID: PMC6929581.
19. Sarlabous M, Psutka DJ. Treatment of Mandibular Ameloblastoma Involving the Mandibular Condyle: Resection and Concomitant Reconstruction With a Custom Hybrid Total Joint Prost-hesis and Iliac Bone Graft. J Craniofac Surg. 2018;29(3):e307-e314. https://doi.org/10.1097/SCS.0000000000004362. PMID: 29381612.
20. Garajei A, Kheradmand AA, Miri SR, Emami A. A retrospective study on mandibular reconstruction using iliac crest free flap. Ann Med Surg (Lond). 2021;66:102354. https://doi.org/10.1016/j.amsu.2021.102354. PMID: 34026108; PMCID: PM C8121997.
21. Shikha N, Upasi AP, Rai KK, Chhikara N, Aftab A, Reghunadhan P. An Analysis of the Viability of Nonvascular Iliac and Fibula Grafts in Mandibular Reconstruction in Patients with Circulatory Diseases: A Prospective Randomized Study. Indian J Otolaryngol Head Neck Surg. 2023;75(1):170-177. https://doi.org/10.1007/s12070
-022-03241-8. Epub 2022 Dec 17. PMID: 37007888; PMCID: PMC10050606.
22. Kumar KPM, Varma S, Vipindas AP, Das Ajay T, Vinod A, Mullath A. Primary Reconstruction in Segmental Resection of Mandible-An Outcome Analysis of Different Reconstructive Techniques. Indian J Otolaryngol Head Neck Surg. 2022;74 (Suppl 3):6155-6163. https://doi.org/10.1007/s12 070-021-02843-y. Epub 2021 Sep 1. PMID: 36742 643; PMCID: PMC9895505.
23. Patel A, Harrison P, Cheng A, Bray B, Bell RB. Fibular Reconstruction of the Maxilla and Mandible with Immediate Implant-Supported Prosthetic Rehabilitation: Jaw in a Day. Oral Maxillofac Surg Clin North Am. 2019;31(3):369-386. https://doi.org/10.1016/j.coms.2019.03.002. Epub 2019 Jun 1. PMID: 31164268.
24. Williams FC. History of the jaw in a day. Oral Maxillofac Surg Cases. 2023;9(2); 100306. https://doi.org/10.1016/j.omsc.2023.100306