Ameloblastoma diagnosed pre-operatively via biopsy, followed by resection.
Right mandible short anterior, long lateral and consists of a segment of mandibular bone with a small amount of mucosa attached superiorly. Two premolars are present towards the anterior
superior end of the specimen. Sectioning reveals a bony lobulated, cystic cavity filled with firm tan to white tissue measuring 18mm in maximal dimension.
The intra-mandible tumour is confirmed to be a primary epithelial odontogenic tumour showing the features of an ameloblastoma. The tumour occupies and expands bone marrow space and focally extends into the overlying cortex but does not penetrate the cortical surface. The tumour extends around but does not infiltrate the intra-osseous nerve present. The tumour is completely excised with no tumour present in either en-face bone surgical resection margin.
Right mandible: excised ameloblastoma.
Tracheostomy through 2nd ring, isthmus divided and secured with silk. Right neck incision, submandibular gland removed. Marginal mandibular, lingual and hypoglossal nerves preserved. Mandibulectomy through canine and lower right second molar after plate prebent.
Left composite radial free flap harvested inset to defect (4.5cm) tri med plate to left radius, closed. Full thickness skin graft, skin paddle to mouth anastamosis. artery end to end, facial vein 1 end to end, EJV cephalic end to side common facial. Closed. vicryl and clips.