Osteo-myo-cutaneous 5th rib-pectoralis major flap in complex mandibular ameloblastoma: A practical solution for low-resources settings

Abstract

Ameloblastoma, representing 1.3 % of all jaw tumors and ranking as the second most prevalent odontogenic neoplasm, is a benign yet locally invasive tumor. In developing countries, patients frequently present with advanced-stage lesions due to delayed medical intervention. Clinically, these tumors manifest as slow-growing, painless masses; however, their aggressive behavior often results in rapid expansion, causing tooth mobility, displacement, and facial deformity. Surgical resection remains the gold standard for management. Preoperative evaluation necessitates a comprehensive assessment of the patient's medical history, tumor location, macroscopic dimensions, and histopathological subtype. Post-resection, significant mandibular defects often necessitate reconstruction to restore shape and function. The fifth rib-pectoralis major osteo-myo-cutaneous flap has emerged as a robust reconstructive option, particularly in resource-limited settings. This technique leverages the flap's acromion-pectoral blood supply to transfer a spade-shaped segment of skin, subcutaneous tissue, and rib with reliability. It facilitates rapid oral rehabilitation, requires no microsurgical expertise, and minimizes operative time.

We present the case of a 44-year-old Rarámuri woman with a seven-year history of a left mandibular mass. Symptomatic progression—marked by pain and oral intolerance—prompted referral to our center. She underwent left mandibulectomy with immediate reconstruction using the osteo-myo-cutaneous flap. Postoperatively, she was discharged on day 14 with a gastrostomy tube and tracheostomy to manage neck edema, tolerating enteral feeds without complications. Follow-up revealed no significant adverse events, underscoring the flap's efficacy in challenging clinical contexts.