Purpose: To present our experience with the management of 33 extensive mandibular ameloblastomas treated with segmental mandibulectomy, reconstruction with free fibula or iliac crest flap, and rehabilitation with immediate or delayed endosteal dental implants.
Patients and methods: The study sample comprised 33 patients with histologically confirmed mandibular ameloblastomas. Primary ameloblastomas were treated in 24 patients, and recurrent ameloblastomas affected 9 patients. Mandibular defect sizes ranged from 3.5 to 12.5. A free fibula osseous or osteocutaneous flap was used 18 times for reconstruction; in the remaining 15, a free iliac crest osseous or osteomuscular flap was chosen. Dental implants were positioned in 26 patients; implant procedures were performed simultaneously with reconstruction in 22 cases.
Results: All flaps were transplanted successfully, and no major complication occurred postoperatively. Final histologic examinations showed 27 multicystic and 6 unicystic ameloblastomas. Free margins were achieved in all patients. The duration of follow-up was 18–120 months (mean, 51.6 months). No patient showed clinical or radiologic signs of recurrence. The dental implant success rate was 100%.
Conclusions: Segmental mandibular resection followed by immediate defect reconstruction with bone-containing free flaps with immediate dental implant placement should be considered as the treatment of choice for extensive mandibular ameloblastomas.