The Three-Dimensional Reconstruction of Soft and Hard Tissues following a Segmental Resection of the Mandible due to an Ameloblastoma

A segmental resection of the mandible is usually required for a reliable removal of a mandibular ameloblastoma. Especially in the mental regionthe three-dimensional reconstruction of the soft and hard tissues is a particular challenge. On the basis of two case presentations, the specific features of a clinical approach will be illustrated. Two patients aged 57 and 59 years were diagnosed with a mandibular ameloblastoma with each showing a similar baseline status. The different follow-up times of 3 and 13 years allow presentable medium-term and long-term results and make a comparison possible. Regular clinical and radiographical follow-up controls took place. The segmental resection in the regions 31 - 34 and 34-36 led to complex defect situations of the bone, teeth and the soft tissues in the affected areas in each case. A staged surgical reconstruction was performed with the microsurgical neurolysis and decompression of the mental nerve, autologous hip bone transplantation with osteosynthesis as well as a delayed dental implant placement with three implants. A vestibuloplasty using a free mucosal graft from the palate and the individualised prosthetic supraconstruction resulted in a favourable revonstructive outcome. After 3 and 13 years after surgery good osseointegration of the implants and favourable results of the hard and soft tissue-recontructions relating function as well as aesthetics, without any limitation of the neural function has been accomplished. This staged reconstructive approach we describe, is a complex procedure but seems to be a reliable method for a functional and aesthetic rehabilitation of these cases. Favourable clinical and radiological results were persistingly observed at three years post interventionem as well as after the long-term observation time of 13 years. Keywords: ameloblastoma, bone defect, augmentation, implant, autologous bone transplantation, segmental resection, soft tissue reconstruction