Facial rehabilitation is one of the greatest challenges in oral and maxillofacial surgery. Generally benign tumours resections are responsible for a major bone and soft tissue loss, originating extensive defects, that brings to the patient aesthetical, functional and social limitations. Similar destruction can be observed in cases of fire guns wounds, osteoradionecrosis and in high energy trauma. Several studies demonstrate the effectiveness of the maxillomandibular complex reconstruction using different bone grafts and internal rigid fixation. Usual donor sites as iliac crest, fibula, ribs, skull, scapula and clavicle are applicable and some can be removed by different techniques as a vascularized or free bone graft. The iliac crest graft offers a great amount of good quality bone that allows large reconstruction with great stability. The rib bone is another feasible option, mainly in children due its growth potential. As important as this first stage of reconstruction, is the proceeding of the treatment planning with the implants installations and prosthetic rehabilitation, returning complete health to the patient. This paper aims to present a case report of a 12-years-old female patient who underwent an ameloblastoma resection and was submitted to a large hemi-mandibular reconstruction using iliac crest and rib bone grafts. A subsequently rehabilitation with implants and prosthesis was started after 5 months of bone healing. Four implants were installed and protocol prosthesis instituted. A six years follow up has been made, presenting great bone stability and no signs of infection or implant losses. With this technique was achieved an optimal aesthetic, an excellent masticatory function and the psychological and social reinsertion.
Mandibular reconstruction and complete oral rehabilitation after amelobastoma resection in a 12-years-old girl
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