We performed immediate reconstruction of the mandible in a patient with ameloblastoma by forming a fresh selfiliac bone segment into the ramus mandibulae after hemimandibulectomy.
The patient was a 27-year-old woman with slight swelling in the region of the right angle of the mandible. As oral findings, redness and slight pressure pain were found in the region from the buccal gingiva corresponding to 8-4 to the transitional zone to the bucca, and parchment crackling was palpable. X-ray examination revealed a polyvacuolar radiotransparent picutre with clear margins in the area from 4 to the mandibular notch and an impacted tooth in the region of the mandibular notch.
The operative procedue was as follows: After hemimandibulectomy according to Manchester's method, the form of the mandible extirpated was reconstructed with a lead plate, and a bone graft segment having the form of the ramus mandibulae was obtained by applying the lead plate to the iliac bone on the same side. Extension bone grafting was performed by making the part corresponding to the caput mandibulae compatible with the mandibular fossa of the temporal bone.
There was no complication due to postoperative infection. Almost no deviation of the jaws at the time of mouth opening was observed 50 days after the operation, when the intermaxillary fixation was removed. The results of a 3-year follow-up was favorable from both cosmetic and functional standpoints.