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Wide excision and microvascular reconstruction for maxillomandibular ameloblastomas: local control, functional, and esthetic outcomes
Deepak Balasubramanian1, Narayana Subramaniam2, Sherry Peter3, Latha Rao3, Pramod Subhash4, Arjun Krishnadas4, V Manju5, Janarthanan Ramu6, Jimmy Mathew6, Mohit Sharma6, Krishnakumar Thankappan1, Subramania Iyer7
1 Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
2 Department of Head and Neck Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bengaluru, Karnataka, India
3 Department of Craniomaxillofacial Surgery, Aster Medicity Hospital, Kochi, Kerala, India
4 Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
5 Department of Prosthodontics, Amrita Institute of Medical Sciences, Kochi, Kerala, India
6 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
7 Department of Head and Neck Oncology; Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
Correspondence Address:
Dr. Deepak Balasubramanian
Department of Head and Neck Surgery and Oncology, Amrita Hospital, Ponnekkara P. O., Kochi - 682 041, Kerala
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jhnps.jhnps_39_18
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Introduction: Ameloblastomas are benign but aggressive odontogenic tumors with have a high propensity for bony destruction. They require to be excised completely to avoid local recurrence, and these resections involve significant functional and esthetic disturbances. With the advent of microvascular reconstruction, they can be excised, and defects are reconstructed with preservation of form and function. This paper presents our experience with wide excision and microvascular reconstruction for maxillomandibular ameloblastomas, and to describe the planning, resection, microvascular reconstruction, and rehabilitation of these patients. Materials and Methods: A retrospective review of records for patients treated with wide excision and microvascular reconstruction for maxillomandibular ameloblastomas at Amrita Institute of Medical Sciences Kochi between 2003 and 2015 was performed. Clinical and pathological features were described, and a literature review was performed. Results: A total of 48 patients were identified with equal sex distribution and mean age at presentation of 35 (range 16–71) years. Half of these patients had primary lesions, and the remaining half had the recurrent disease (range 1–4 previous surgeries). Forty patients (83%) had mandibular lesions and the remaining had the maxillary disease. All patients had wide excision with a gross bony margin of 1 cm and reconstruction with microvascular flaps (fibula free flap = 41, distal circumflex iliac artery flap = 3 and scapular free flap = 2, anterolateral thigh flap = 1 and radial forearm free flap = 1). Mean tumor size was 4.73 (2–14) cm. At a median follow-up of 21 months, all patients were free of recurrence. Successful dental rehabilitation was achieved in 40 patients (83%). Conclusion: This approach leads to results in excellent local control, functional, and esthetic outcomes. Although managing these patients is challenging, multidisciplinary expertise and planning are crucial for successful management.
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