Wide excision and microvascular reconstruction for maxillomandibular ameloblastomas: local control, functional, and esthetic outcomes
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...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2018-01-01
|
| Series: | Journal of Head & Neck Physicians and Surgeons |
| Subjects: | |
| Online Access: | http://www.jhnps.org/article.asp?issn=2347-8128;year=2018;volume=6;issue=2;spage=82;epage=85;aulast=Balasubramanian |
| _version_ | 1818518259022954496 |
|---|---|
| author | Deepak Balasubramanian Narayana Subramaniam Sherry Peter Latha Rao Pramod Subhash Arjun Krishnadas V Manju Janarthanan Ramu Jimmy Mathew Mohit Sharma Krishnakumar Thankappan Subramania Iyer |
| author_facet | Deepak Balasubramanian Narayana Subramaniam Sherry Peter Latha Rao Pramod Subhash Arjun Krishnadas V Manju Janarthanan Ramu Jimmy Mathew Mohit Sharma Krishnakumar Thankappan Subramania Iyer |
| author_sort | Deepak Balasubramanian |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T01:07:32Z |
| format | Article |
| id | doaj.art-9ecd28b097824e9fb60ba7269fd29407 |
| institution | Directory Open Access Journal |
| issn | 2347-8128 2347-8128 |
| language | English |
| last_indexed | 2024-12-11T01:07:32Z |
| publishDate | 2018-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Head & Neck Physicians and Surgeons |
| spelling | doaj.art-9ecd28b097824e9fb60ba7269fd294072022-12-22T01:26:07ZengWolters Kluwer Medknow PublicationsJournal of Head & Neck Physicians and Surgeons2347-81282347-81282018-01-0162828510.4103/jhnps.jhnps_39_18Wide excision and microvascular reconstruction for maxillomandibular ameloblastomas: local control, functional, and esthetic outcomesDeepak BalasubramanianNarayana SubramaniamSherry PeterLatha RaoPramod SubhashArjun KrishnadasV ManjuJanarthanan RamuJimmy MathewMohit SharmaKrishnakumar ThankappanSubramania IyerIntroduction: 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.http://www.jhnps.org/article.asp?issn=2347-8128;year=2018;volume=6;issue=2;spage=82;epage=85;aulast=BalasubramanianAmeloblastomadental rehabilitationfibula free flapmicrovascular reconstruction |
| spellingShingle | Deepak Balasubramanian Narayana Subramaniam Sherry Peter Latha Rao Pramod Subhash Arjun Krishnadas V Manju Janarthanan Ramu Jimmy Mathew Mohit Sharma Krishnakumar Thankappan Subramania Iyer Wide excision and microvascular reconstruction for maxillomandibular ameloblastomas: local control, functional, and esthetic outcomes Journal of Head & Neck Physicians and Surgeons Ameloblastoma dental rehabilitation fibula free flap microvascular reconstruction |
| title | Wide excision and microvascular reconstruction for maxillomandibular ameloblastomas: local control, functional, and esthetic outcomes |
| title_full | Wide excision and microvascular reconstruction for maxillomandibular ameloblastomas: local control, functional, and esthetic outcomes |
| title_fullStr | Wide excision and microvascular reconstruction for maxillomandibular ameloblastomas: local control, functional, and esthetic outcomes |
| title_full_unstemmed | Wide excision and microvascular reconstruction for maxillomandibular ameloblastomas: local control, functional, and esthetic outcomes |
| title_short | Wide excision and microvascular reconstruction for maxillomandibular ameloblastomas: local control, functional, and esthetic outcomes |
| title_sort | wide excision and microvascular reconstruction for maxillomandibular ameloblastomas local control functional and esthetic outcomes |
| topic | Ameloblastoma dental rehabilitation fibula free flap microvascular reconstruction |
| url | http://www.jhnps.org/article.asp?issn=2347-8128;year=2018;volume=6;issue=2;spage=82;epage=85;aulast=Balasubramanian |
| work_keys_str_mv | AT deepakbalasubramanian wideexcisionandmicrovascularreconstructionformaxillomandibularameloblastomaslocalcontrolfunctionalandestheticoutcomes AT narayanasubramaniam wideexcisionandmicrovascularreconstructionformaxillomandibularameloblastomaslocalcontrolfunctionalandestheticoutcomes AT sherrypeter wideexcisionandmicrovascularreconstructionformaxillomandibularameloblastomaslocalcontrolfunctionalandestheticoutcomes AT latharao wideexcisionandmicrovascularreconstructionformaxillomandibularameloblastomaslocalcontrolfunctionalandestheticoutcomes AT pramodsubhash wideexcisionandmicrovascularreconstructionformaxillomandibularameloblastomaslocalcontrolfunctionalandestheticoutcomes AT arjunkrishnadas wideexcisionandmicrovascularreconstructionformaxillomandibularameloblastomaslocalcontrolfunctionalandestheticoutcomes AT vmanju wideexcisionandmicrovascularreconstructionformaxillomandibularameloblastomaslocalcontrolfunctionalandestheticoutcomes AT janarthananramu wideexcisionandmicrovascularreconstructionformaxillomandibularameloblastomaslocalcontrolfunctionalandestheticoutcomes AT jimmymathew wideexcisionandmicrovascularreconstructionformaxillomandibularameloblastomaslocalcontrolfunctionalandestheticoutcomes AT mohitsharma wideexcisionandmicrovascularreconstructionformaxillomandibularameloblastomaslocalcontrolfunctionalandestheticoutcomes AT krishnakumarthankappan wideexcisionandmicrovascularreconstructionformaxillomandibularameloblastomaslocalcontrolfunctionalandestheticoutcomes AT subramaniaiyer wideexcisionandmicrovascularreconstructionformaxillomandibularameloblastomaslocalcontrolfunctionalandestheticoutcomes |