Massive Ameloblastoma and Reconstruction with Free Fibular Graft

Aims: To report a case of massive ameloblastoma in mandible with wide excision and reconstruction with free vascularized fibular graft and titanium plate. Case Description: A 49- year-old male patient complained right facial mass since 5 years ago. Patient underwent right hemimandibulectomy with general anesthesia and pathologic examination revealed folliculare ameloblastoma. The large defect after resection reconstructed with free fibular graft. Fibula was osteotomised and resembled with mandible shape and reconstructed by plate with intact pedicle. Care was taken to protect the periosteal branch of the peroneal artery before performing an osteotomy. Shaping of the resected fibula was done according to the preoperative template. A titanium miniplate with locking screws was used to secure the osteotomized fibula and the mandible. To secure the airway, we performed tracheostomy. Followup after operation, patient still got a defect facial asymmetry in right mandible. Discussion: Ameloblastoma is histologically benign but locally aggressive tumor originating from odontogenic epithelium. After hemimandibulectomy, reconstruction continued with microvascular free fibular graft and titanium plate. Osteotomies were performed with the pedicle still attached. Conclusions: Free vascularized fibular graft with titanium plate is preferrably reconstruction option for large defect after wide excision of mandibular ameloblastoma.

Comparison of the Stability of Mandibular Sagittal Osteotomy Fixation between Two Types of Titanium Miniplates: A Biomechanical Study in Sheep Mandibles

This study aimed to compare the biomechanical stability of the fixation of mandibular sagittal split osteotomy of the ramus by two types of titanium miniplates in sheep mandibles. Seven preserved sheep mandibles with similar weight and size were selected, dissected with complete removal of soft-tissue structures, and sectioned in their midline. After performing sagittal split osteotomy, 5 mm of advancement was standardized and samples were divided into two groups according to the type of titanium miniplate (GI = seven hemimandibles were fixed with straight titanium miniplate, GII = seven hemimandibles were fixed with L-shaped titanium miniplates), and then subjected to compressive load. The means (standard deviation) of the compressive load and extension values were 70.68 N (22.26) and 63.36 mm (15.60) to straight miniplates, and 78.80 N (32.54) and 70.55 mm (5.42) to L-shaped miniplates. After comparison and statistical analysis, the results showed no significant difference between the two types of titanium miniplates.