Multidisciplinary management of an advanced mandibular ameloblastoma: Etiopathogenesis, surgical management and prosthetic rehabilitation

Background

The ameloblastoma is a benign but locally aggressive epithelial odontogenic neoplasm. Although rare, the ameloblastoma is the most common odontogenic tumor associated with the maxillofacial complex which possesses a significant propensity for local recurrence in the setting of conservative treatment. Concordantly, definitive therapy is predicated on wide surgical excision with reconstruction of ablative defects dictated by the resultant tissue defects. The purpose of this report is to highlight specific treatment and reconstructive challenges, emphasizing the essential need for collaborative patient care within a large multidisciplinary team.

Case description

A 31-year-old Vietnamese-speaking male was referred for management of an extensive ameloblastoma associated with the left mandible. Management consisted of a bilateral composite mandibular resection and reconstruction via free tissue transfer utilizing an osteocutaneous fibular free flap. Histopathologic analysis confirmed the diagnosis of a conventional ameloblastoma. Delayed oral rehabilitation employing virtual surgical planning to facilitate the placement of endosseous implants with immediate loading of a fixed acrylic prosthesis was accomplished in the post-operative period without any evidence of recurrence.

Practical implications

Multidisciplinary collaboration in the setting of advanced odontogenic tumors is paramount in enhancing treatment outcomes. This case strengthens the need for accurate and rapid diagnosis in the primary care setting with collaborative interprofessional management utilizing advances in digital technologies to optimize both functional and aesthetic outcomes which have significant influence over long-term quality-of-life.