Keywords
Maxillectomy
Maxillofacial reconstruction
Fibula free flap
Virtual surgical planning
How to Cite
Abstract
Introduction: Ameloblastoma is a rare, benign odontogenic tumor characterized by locally invasive behavior. Maxillary ameloblastomas are uncommon and tend to exhibit a more aggressive clinical course, with greater infiltration of adjacent structures, difficulty in achieving adequate surgical margins, and a higher risk of recurrence. Reconstruction of extensive maxillary defects remains challenging because of the anatomical and functional complexity of the midface.
Methods: We present the case of a 44-year-old male patient with an ameloblastoma of the right maxilla who underwent a Brown and Shaw class IIIb hemimaxillectomy. Immediate reconstruction was performed using an osteocutaneous fibula free flap, assisted by computer-aided design and computer-aided manufacturing (CAD/CAM) virtual surgical planning and patient-specific cutting guides. The fibula was divided into two osseous segments to reconstruct the alveolar ridge and zygomaticomaxillary buttress. Two skin paddles were used to reconstruct the palate and medial wall of the maxillary sinus, and a titanium mesh was used for orbital floor reconstruction.
Results: The patient had a favorable postoperative course, with satisfactory restoration of midfacial contour, effective separation of the oral and nasal cavities, and preservation of swallowing, speech, and oral competence. Early exposure of the titanium mesh was successfully managed with a local advancement flap, without compromising free flap viability or the overall reconstructive outcome.
Conclusion: The osteocutaneous fibula free flap combined with CAD/CAM-based virtual surgical planning represents a versatile and reliable reconstructive option for complex maxillary defects, allowing restoration of both anatomy and function while preserving the possibility of future rehabilitation with osseointegrated dental implants.
References
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