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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
A Journal on Maxillofacial Surgery
Official Journal of the Italian Society of Maxillofacial Surgery
Rivista Italiana di Chirurgia Maxillo-Facciale 2004 April;15(1):29-34
Desmoplastic ameloblastoma of the mandible. Subtotal reconstruction with fibula flap. A case report
Pesucci B. 1, Boccieri A. 1, Lattanzi A. 1, Zoani P. 1, Montemari G. 2, Felici N. 2, Bellocchi G. 3
1 Division of Maxillofacial Surgery San Camillo-Forlanini Hospital, Rome, Italy
2 Division of Plastic and Reconstructive Surgery San Camillo-Forlanini Hospital, Rome, Italy
3 Division of ORL Surgery
Desmoplastic ameloblastoma is an uncommon variant of ameloblastoma possessing particular anatomical, histological and radiographic features. Characterized by stromal desmoplasia, this tumor tends to be located in the anterior region of both the maxillary and the mandible. In radiological terms, it presents itself as a lesion with alternating radiolucent and radiopaque areas.
The disease occurs in both sexes, normally around the age of forty. The article presents a case of desmoplastic ameloblastoma of the mandible in a male patient aged 72. The lesion was unusual with respect to the other desmoplastic lesions reported in the literature. In fact, this lesion involved almost all the mandible in terms of its bilateral extension, which was probably due to long time of growth, given the age of the patient. The large-scale surgical demolition carried out required subtotal reconstruction of the mandible by means of a microvascular portion of fibula. Preliminary study of the bone resection carried out by means of TC and stereolythographic model had indicated for a 20 cm stretch of fibula. The flap was osteotomized into 5 segments fixed with miniplates. In this case we have to consider the large and extended demolition and the possibility offered by this flap to give a quite normal form of the mandibular arch and a secondary prostethic rehabilitation.