A treatment algorithm for managing giant mandibular ameloblastoma: 5-year experiences in a Paris university hospital

Abstract Aims To review our experiences with giant mandibular ameloblastoma (GMA) over a 5-year period, and to formulate a treatment algorithm for managing this tumour. Methods We retrospectively reviewed all GMA patients who underwent segmental mandibulectomy and immediate free fibular osteoseptocu...

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Bibliographic Details
Published in:European journal of surgical oncology 2009-09, Vol.35 (9), p.999-1005
Main Authors: Chaine, A, Pitak-Arnnop, P, Dhanuthai, K, Ruhin-Poncet, B, Bertrand, J.-Ch, Bertolus, C
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Algorithms
Ameloblastoma - surgery
Female
Fibula - transplantation
Fibular free flap
Giant ameloblastoma
Hematology, Oncology and Palliative Medicine
Humans
Immediate reconstruction
Jaw tumour
Male
Mandibular Neoplasms - surgery
Microvascular surgery
Middle Aged
Osteotomy - methods
Paris
Retrospective Studies
Surgery
Surgical Flaps - blood supply
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Summary:Abstract Aims To review our experiences with giant mandibular ameloblastoma (GMA) over a 5-year period, and to formulate a treatment algorithm for managing this tumour. Methods We retrospectively reviewed all GMA patients who underwent segmental mandibulectomy and immediate free fibular osteoseptocutaneous flap reconstruction (SM-IFFOFR) by a single reconstructive team from 2002 to 2006. All treatment methods and outcomes were analysed. Findings Forty-four ameloblastoma patients were operated upon during this study period. Sixteen cases had GMA, of which 9 patients were included in this series (mean age: 35 years). The defects in the mandible ranged from 7 to 16 cm in length (mean: 12 cm). The average length of the harvested fibula was 11 cm, and the number of osteotomies ranged from 1 to 2. The mean ischemic time was 137 min (range: 90–180 min). Neck recipient vessels were used for flap perfusion in all cases. All but one flaps were viable without any complications, whilst partial skin-island necrosis occurred in 2 patients. Hospital stay was 2 weeks in most of the patients. No tumour recurrence was found during the follow-up period (range: 26–73 months). Dental implants were placed in 2 patients. Conclusions Despite several limitations of this study, we suggest that a radical approach with the SM-IFFOFR is an effective treatment for GMA. Further well-designed, larger series with longer follow-up periods are still encouraged.
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2009.04.006