Reconstructive surgery in a patient with a reccurence of a follicular ameloblastoma of the left maxilla

Introduction:

Ameloblastomas are rare, locally aggressive tumours which derive from odontogenic epithelium (ameloblasts). Because the recurrence rates are very high, they present a challenge for head and neck surgeons.

Case report:

A 61-year old patient presents with a reccurence of a known ameloblastoma of the left maxilla. The initial diagnosis was given in 2007, since then the patient underwent five surgeries. At presentation the patient had maxillar pain but denied diplopic images or impaired vision. Radiological imaging showed an osteodestructive lesion in the left maxillary sinus and left zygomatic bone with breakthrough into the left periorbita without infiltration of the intraorbital muscles.

Results:

The tumour was surgically approached through an extended lateral rhinotomy and resected by a partial maxillectomy. Reconstruction was achieved with a microvascular anastomosis of a free parascapular flap transfer. Immunohistochemistry confirmed the diagnosis of a follicular ameloblastoma with tumour free margins, Postoperatively the patient did not have double vision and the facial outline was almost symmetrical.

Conclusion:

Ameloblastomas are locally aggressive odontogenic tumours with high reccurence rates. Curative therapy is the radical excision. Follow-up should be performed regularly with clinical and radiological examination.

Publication History

Publication Date:
23 April 2019 (online)