Giant Mandibular Tumors: A Retrospective Clinical Series

Giant tumors of the mandible present a formidable challenge in treatment and reconstruction. Large tumors destroy the normal anatomy of the mandible and present with aesthetic and functional problems. Although the mainstay of treatment is surgery, adjuvant oncological management maybe indicated for metastatic disease

The authors reported a series of 7 patients from 2000 to 2005 with giant tumors of the mandible. Five of them were ameloblastomas, 1 sarcoma, 1 adenocystic carcinoma. None of the patients had metastatic disease.

All the patients, after a clinical and radiologic assessment, underwent wide local excision of the tumor. One of the patients with very large tumor underwent a delayed near total mandibular reconstruction with a double free flap. The other 6 patients underwent an immediate reconstruction. In this group, 1 patient had a first stage reconstruction with a reconstruction plate, and 5 patients had free vascularized bone grafting for the defect. Three patients required tempromandibular joint reconstruction. Miniplates were used for the fixation in 5 patients and reconstruction plates in 2. One of resections was performed as an emergency because of major bleed from the tumor.

The patient who had double free flap delayed reconstruction had a failure of the fibula osseocutaneous flap. Salvage was attempted by removing only the skin portion of the flap. The bone and the viable free radial forearm flap were retained. The patient developed osteitis of the bone and presented with multiple sinuses. She was then treated with long–term antibiotics and hyperbaric oxygen. The sinuses healed. The patient improved, but with a less than satisfactory result.

Patients who received an immediate reconstruction did well functionally and cosmetically. All patients who had the tempromandibular joint reconstructed achieved good functional results. In two patients on whom the head and neck surgeons performed the resection, marginal mandibular nerve palsy resulted, providing a compromised result.

Large mandibular tumors expand the mandible to proportions that result in major functional and aesthetic problems. Treatment needs to be directed toward adequate resection. The soft tissues are displaced but often uninvolved. The large size may persuade the surgeon into thinking that the tumor is not resectable. Microsurgical replacement of the mandible by an immediate reconstruction following an adequate resection are the mainstay treatment for large mandibular tumors.