Mandibular Reconstruction Using Costochondral Rib Graft In A Growing Patient: 3 Years 9 Months Follow Up.

摘要

Unicystic ameloblastoma refer to those cystic lesions that show clinical, radiographic, or gross features of a mandibular cyst, but on histologic examination they show a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor growth. Due to its strong likelihood of recurrence, curettage or mass excision without a safety margin is not recommended for the treatment. The goal of treatment ameloblastoma is to achieve complete excision and appropriate reconstruction. Mandibular reconstruction after resection is essential for the restoration of function and cosmesis, particularly in children. Costochondral grafts have been used for many years in reconstruction of TMJ and mandible. This is a report on unicystic ameloblastoma in a 12 year old patient treated by resection and reconstructed with costochondral graft and followed up for 3 years 9 months. Introduction Ameloblastoma is a true neoplasm of the odontogenic epithelium, representing about 1% of all oral ectodermal tumors and 9% of odontogenic tumors[1]. The unicystic ameloblastoma is considered a variant of the solid or multicystic ameloblastoma, accounting for 6% to 15% of all intraosseous ameloblastomas. Unicystic ameloblastoma usually occur in the younger age group and commonly involves the mandible. Unicystic ameloblastoma is a tumour with a strong propensity for recurrence, warranting complete excision[2]. The most challenging aspect in maxillofacial surgery in treating such a lesion in a growing patient is not just radical tumour resection but the reconstruction of resected portion. Hemimandibulectomy in young patients alters and restricts the mandibular movements leading to severe cosmetic and functional deformity including speech, mastication and deglutition [3]. Immediate reconstruction in such situations permits stress-stable positioning of condylar stumps thereby retaining the soft tissue position and contour of lower part of face [4]. Among the numerous autogenous and alloplastic techniques available for reconstruction, autogenous costochondral graft have been widely accepted for use in growing children. The histologic and physiologic similarities between the condyle and rib cartilage have been well documented and the bone-cartilage junction provides a centre with growth potential in children [5].The aim of presenting this case is to report our experience with costochondral graft in reconstruction after hemimandibulectomy in an 11 year old patient with unicystic ameloblastoma.