Saraiya Hemant A
Saraiya Plastic Surgery and Burns Hospital, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
Indian J Plast Surg. 2020 Dec;53(3):363-370. doi: 10.1055/s-0040-1719198. Epub 2020 Nov 24.
Ameloblastoma is a benign yet locally aggressive odontogenic tumor of the jaw with high recurrence rates. Despite many studies, the search is still on for the treatment approach which can render the acceptable recurrence rates with good functional and esthetic results. In this prospective study, we operated on 37 patients of mandibular ameloblastoma between 2009 and 2018. Two patients were treated with curettage and chemical sterilization of the cavity. Resection of a tumor with a 2-cm margin was performed in the rest of 35 patients. The mandibular defect was primarily reconstructed with the microvascular free fibular flap in 29 patients. The follow-up ranged from 6 months to 7.7 years with a mean of 5.1 years. A tumor recurred within a year in all two patients (100%) treated with curettage. Out of 35 radical excisions, only one patient (2.85%) developed recurrence 3 years after the disease-free interval. Good mouth opening, intelligible speech, satisfactory lower jaw shape, and facial profiles were achieved in all 29 patients who were treated with primary free fibular flap. We prefer wide excision with 2-cm margins on each side of a tumor with the primary reconstruction of the mandible in all cases of mandibular ameloblastoma. The free fibular microvascular flap is our treatment of choice as all defects of the mandible can be reconstructed with the free fibular flap. Wide excision is the key to prevent a recurrence.
成釉细胞瘤是一种良性但具有局部侵袭性的颌骨牙源性肿瘤,复发率很高。尽管进行了许多研究,但仍在寻找一种能使复发率可接受且功能和美学效果良好的治疗方法。
在这项前瞻性研究中,我们在2009年至2018年期间对37例下颌成釉细胞瘤患者进行了手术。2例患者接受了刮除术及腔隙化学消毒治疗。其余35例患者进行了肿瘤切除,切缘为2厘米。29例患者主要采用游离腓骨微血管皮瓣一期修复下颌骨缺损。
随访时间为6个月至7.7年,平均5.1年。接受刮除术治疗的2例患者(100%)均在1年内复发。在35例根治性切除病例中,仅1例患者(2.85%)在无病间隔3年后复发。所有29例接受游离腓骨皮瓣一期修复的患者均获得了良好的开口度、清晰的语音、满意的下颌外形和面部轮廓。
对于所有下颌成釉细胞瘤病例,我们倾向于在肿瘤两侧各有2厘米切缘的广泛切除,并一期重建下颌骨。游离腓骨微血管皮瓣是我们的首选治疗方法,因为所有下颌骨缺损都可以用游离腓骨皮瓣进行修复。广泛切除是预防复发的关键。
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