Abstract
We describe a case of recurrent ameloblastoma in left mandible where segmental resection was performed and reconstructed using distraction osteogenesis with segmental bone transport.We present a 52-year-old male patient with a complaint of painless gingival swelling in the left mandible. He had a history of treatment for ameloblastoma 26 years earlier in the left mandibular first molar area. Marginal mandibular resection along with a wide range of surrounding soft tissues was performed. Distraction osteogenesis was applied for the mandibular reconstruction with segmental bone transport method, after fixing the inferior border of mandible with a dynamic bridging plate for added strength.
Distraction osteogenesis is a versatile method compared to simple bone grafts to reconstruct mandibular defects with new regenerated bone and elongated soft tissue such as mucosa and nerve. However, the strength of the remaining mandibular bone after marginal resection was insufficuent to reconstruct using the segmental bone transport method in this case. Some reinforcement device was needed to add strength to the mandible without compromising mobility of the bone transport segment.
Therefore, a dynamic bridging plate, which could be bent to the desired contour was applied as a reinforcement device to the inferior border of the mandible. We could secure the distractor device on the buccal side of the mandible to achieve the better alignment of the regenerative tissue without compromising on support provided by the dynamic bridging plate fixed in the inferior portion. As a result, good regeneration of new bone and soft tissues was achieved. Five years after surgery, the patient has good functional results with a mandibular partial denture and without any recurrence of the tumor.
In conclusion, segmental bone transport with a dynamic bridging plate was an effective method which can be applied after surgery of malignant tumors as well as benign tumors for the reconstruction of the defected areas of bone and soft tissues. Furthermore, distraction osteogenesis has potential for reconstruciton of any large bony and soft tissue defects if provided with stable reinforcement plating.
