Clinical Case Reports

Biography

Biography: Narjiss Akerzoul

Abstract

Introduction: The ameloblastoma is a rare odontogenic tumor of the oral cavity. It affects more the mandible than the maxilla and has a predilection for the posterior region. Although this tumor is benign, its behavior is locally aggressive and requires the most often surgical resection margin. Clinical Observation: A young woman aged 28 has consulted the service of Oral Surgery Department of Rabat, complaining of right mandibular swelling lasting for eight months. Panoramic radiography revealed the presence of a multi-geodic lesion at the right hemi-mandible. A biopsy was performed at the level of the lesion and concluded an ameloblastoma. The patient was subsequently referred to the Maxillofacial Surgery Service of the Hospital of Specialties of Rabat. Two teams, one of maxillofacial surgery and another one for vascular surgery, collaborated to perform a hemi-mandibulectomy with a free fibula flap. Discussion: The indication of radical or conservative treatment should be guided by the anatomical location of the lesion, the radiological aspect and especially macroscopic intra-operative. Conservative treatment is carried out for non extensive lesions with the assurance of a future clinical monitoring. Bone resection with or without immediate reconstruction is needed in extended forms, breaking cortical bone, the periosteum and soft tissue invasiveness. The free fibula flap was the preferred graft for oromandibular reconstruction because of its rich blood supply and the consistency in the size of the fibula bone and stability. The free fibula flap allows skin palette to be obtained that is up to 25 cm long and 5 cm wide. Thanks to the fibula periosteal vascularization, the fibula bone can withstand multiple osteotomies without compromising significantly, when the periosteum is left set. The free fibula flap can be considered a reliable recommended flap with low morbidity and also adapted for future dental rehabilitation