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The Role of Free Fibula Flap in the Reconstruction of a Mandibular Ameloblastoma: A Case Report

Narjiss Akerzoul, Saliha Chbicheb, Wafaa Elwady


Introduction: The ameloblastoma is a rare odontogenic tumor of the oral cavity. It affects more the mandible than the maxilla, and has a predilection for the posterior region. Although this tumor is benign, its behavior is locally aggressive and requires the most often surgical resection margin.
Case  Report: A young woman aged 28,  has consulted the Oral Surgery Department of Rabat, complaining of a  right mandibular swelling, extended from the 46 to the right mandibular ramus, lasting for eight months. The intraoral examination revealed a swelling covered of a mucosa of normal appearance.  Panoramic radiograph revealed the presence of a multi-geodic lesion at the right hemi-mandible. A biopsy was performed at the level of the lesion and concluded an ameloblastoma. The patient was subsequently referred to the Maxillofacial Surgery Service of the Hospital of Specialties of Rabat. Two teams, one of maxillofacial surgery and another one for vascular surgery, collaborated to perform a hemi-mandibulectomy with a free fibula flap graft.

Conclusion : The free fibula osteocutaneous flap is the most versatile and reliable option for microsurgical reconstruction of large mandibular defects.


Free Fibula Flap; Ameloblastoma; Mandibular Reconstruction


Pogrel MA, Podlesh S, Anthony JP, et al. A comparison of vascularised and nonvascularised bone grafts for reconstruction of mandibular continuity defects. J Oral Maxillofac Surg. 1997, 55:1200-1206

Gilbert A. Vascularised transfer of the fibular shaft. Int J Micro- surg. 1979, 1:100

Taylor GI, Miller DH, Ham FJ. The free vascularised bone graft. A clinical extension of microvascular techniques. Plast Recon- str Surg. 1975, 55:533

Hidalgo A. Fibula free flap. A new method of mandible recon- struction. Plast Reconstr Surg. 1989, 84:71

Wei F, Seah C, Tsai Y, et al. Fibula osteoseptocutaneous flap for reconstruction of composite mandibular defects. Plast Recon- str Surg. 1994, 93:294

Yoshimura M, Shimada T, Hosokawa M. The vasculature of the peroneal tissue transfer. Plast Reconstr Surg. 1990, 85:917

Beppu M, Hanel D, Johnston G, et al. The osteocutaneous fibula flap: An anatomic study. J Reconstr Microsurg. 1992, 8:215

Graham RG, Swan MC, Hudson DA, et al. The fibula free flap: Advantages of the muscle sparing technique. Br J Plast Surg. 2008, 56:388

Jewer DD, Boyd JB, Manktelow RT, et al. Orofacial and man- dibular reconstruction with the iliac crest free flap: A review of 60 cases and a new method of classification. Plast Reconstr Surg. 1989, 84:391

Munoz Guerra MF, Gias LN, Rodriguez Campo FJ. Vascularised free fibular flap for mandibular reconstruction: A report of 26 cases. J Oral Maxillofac Surg. 2011, 59:140

Schliephake H, Neukam FW, Schmelzeisen R, et al. Long-term quality of life after ablative intraoral tumor surgery. J Crani- omaxillofac Surg. 1995, 23:243

Wilson KM, Rizk NM, Armstrong SL, et al. Effects of hemiman- dibulectomy on quality of life. Laryngoscope. 1998, 108:15-34

Zlotolow I, Huryn J, Piro J, et al. Osseointegrated implants and functional prosthetic rehabilitation in microvascular fibular free flap reconstructed mandibles. Am J Surg. 1992, 165:673-677

Ghara A, Darwich K, Li L, et al. Long-term results of jaw reconstruction with microsurgical fibula grafts and dental im- plants. J Oral Maxillofac Surg. 2015, 65:1005

Hölzle F, Kesting MR, Hölzle G, et al. Clinical outcome and patient satisfaction after mandibular reconstruction with free fibula flaps. Int J Oral Maxillof Surg. 2014, 36:805

Thorwarth M, Eulzer C, Bader R, Wolf C, Schmidt M, Schultze-Mosgau S. Free flap transfer in cranio-maxillofacial surgery: a review of the current data. Oral Maxillofac Surg. 2010, 12(3):113-124

Smith RB, Sniezek JC, Weed DT, Wax MK. Utilization of free tissue transfer in head and neck surgery. Otolaryngol Head Neck Surg. 2014, 137:182-191

Yang G, Chen B, Gao Y, Liu X, Li J, Jiang S, He S. Forearm free skin flap transplantation. Natl Med J China. 1981, 61:139-141

Rosenthal E, Couch M, Farwell DG, Wax MK. Current concepts in microvascular reconstruction. Otolaryngol Head Neck Surg. 2015, 136:519-524

Okay D, Genden E, Buchbinder D, Urken M. Prosthodontic guidelines for surgical reconstruction of the mandible. The journal of prosthetic dentistry. 2011, 86:352-363

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