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Introduction: Ameloblastoma is a benign tumor of odontogenic epithelium with a tendency to local recurrence if not removed appropriately. Reconstruction alternatives include the use of microvascularized free flaps, plates and customized titanium prostheses. Objective: Describe a case of mandibular replacement with a customized titanium prosthesis after ameloblastoma excision. Case presentation: A case is presented of a female 44-year-old patient who presented a radiographic finding during pulporadicular treatment of tooth 37. Facial physical examination found an increase in volume in the left genian region, and intraoral observation detected expansion of the corticals in the lower posterior arch of the same side. Panoramic radiography and computed axial tomography showed a multilocular radiolucid image resembling soap bubbles which extended from the mandibular body to the left condyle. A sample was taken for biopsy, which confirmed the diagnosis of follicular pattern ameloblastoma. Segmental mandibular surgery was performed by cervical approach with a safety margin and exarticulation. The portion removed was replaced with a customized titanium prosthesis. Post-operative control showed a good evolution. Conclusions: Surgery was the basic component of the treatment applied. Surgical resection was followed by reconstruction of the defect with a customized titanium prosthesis, a procedure of great novelty in our environment useful to restore function and esthetic appearance.

Ameloblastoma is a benign dental tumor mostly found in the mandible, with several variations. The treatment of this pathology ranges from simple enucleation to resection of large sections of the affected bone. There are several options for correcting the sequelae of ameloblastoma treatment, including the use of grafts and currently microvascular free flaps, which have become the standard treatment. This report describes a clinical case of a large mandibular ameloblastoma, which was resected with safety margins about 10 years ago, reconstructed by free grafts in successive surgical times and rehabilitated using removable prostheses. The question is then what the best option is today in the reconstruction of patients affected by this type of pathologies, taking into account emerging options, the clinicians’ learning curve and the patients’ resources.

En el 2017 la Organización Mundial de la Salud describió al ameloblastoma como una neoplasia benigna, localmente invasiva, consistente en una proliferación de epitelio odontogénico, que usualmente presenta un patrón folicular o plexiforme, y se encuentra dentro de un estroma fibroso. Cursa con un lento crecimiento y gran afinidad por el tejido óseo, presenta un alto índice de recurrencia, aproximadamente de 60 a 80%, si no es removido de la manera adecuada. Algunas variantes como la uniquística y la desmoplásica cuentan con un mejor pronóstico que la sólida o multiquística. Representan el 1% de todos los tumores de la mandíbula y el 11 % de todos los tumores odontogénicos. Se presenta el caso clínico de un paciente masculino de 43 años de edad que acude a nuestro servicio en el 2016 por presentar aumento de volumen con un año de evolución, asintomático, y con principios de movilidad dental en la zona mandibular izquierda. A la exploración intraoral se aprecia aumento de volumen en región mandibular con un incremento de expansión de las corticales, lo cual es involucrado desde la pieza dentaria 36 a la 41, no presenta sintomatología dolorosa a la palpación ni a la percusión.

Background: the unicystic ameloblastoma (UA) is considered a variant of ameloblastoma, with particular clinica-radiographic and histological characteristics, showing a better prognosis than the solid/ multicystic type. Objective: to describe the managing and procedures of a patient with an unicystic ameloblastoma intramural (IMUA) with emphasis in the late reconstruction and rehabilitation. Matherials and methods: a case of an 18-year-old male with a painless lesion in the mandibular anterior area, related to an impacted tooth. Radiographically, it showed a unilocular, corticalized image, which caused expansion of the cortical plates, a segmental resection and reconstruction plate placement was performed; in a second surgical time, autologous bone graft was placed and subsequent rehabilitation with implants. Discussion: the article discusses the choice of treatment based on the lesion biological behavior, as well as the need to restore aesthetics and function after radical surgery.

Introduction: overly delayed initial treatment is one the factors leading to persistent deformities after craniofacial trauma. Ideal mandibular reconstruction will create a solid dental arch which will articulate with the maxilla and restore speech, swallowing, mastication and esthetics. Objective: present a case of mandibular reconstruction of a posttraumatic mandibular deformity. Case presentation: a 49-year-old female patient can only feed herself liquid food after a craniofacial trauma undergone six months before. Physical examination revealed facial asymmetry with an increase in the vertical dimension of the lower third of the face and bilabial incompetence. Oral examination, on the other hand, revealed that the patient had a totally edentulous upper dental arch and partial prosthetic rehabilitation of the maxillary arch, impossibility of oral closure, and the presence of a visible step on the residual ridge at the 45 and distal 37. Diagnosis was a posttraumatic deformity due to bilateral mandibular fracture. Evaluation was carried out in joint coordination with the prosthesis service, and it was decided to perform surgical mandibular reconstruction by cervical approach, refracture, mandibular relocation with fixation of the occlusal guide, and placement of load bearing mandibular plates with bicortical screws. Outpatient follow-up was conducted after hospital discharge. The patient states that she is very pleased with her esthetic appearance and the functional improvement achieved. Conclusions: posttraumatic sequelae are frequently accompanied by damage to soft and hard tissues of the facial region with varying degrees of esthetic and functional alteration. Restoration by means of facial reconstruction is often a professional challenge which may be best tackled with a team, transdisciplinary therapeutic approach.

La necesidad de una reconstrucción mandibular está dictada por la pérdida de hueso debido, entre otras causas, a trauma. El propósito de este trabajo es caracterizar un caso de reconstrucción mandibular de una deformidad posquirúrgica por trauma. Se trata de un paciente masculino de 34 años que acude a consulta por inconformidad estética y dificultad para masticar. Aproximadamente un año atrás había padecido un trauma facial, por lo cual fue atendido de urgencia e intervenido quirúrgicamente. Se realizó estabilización ósea y colocación de placa de reconstrucción mandibular. Presentaba asimetría facial, disminución del tercio inferior facial y movilidad de los segmentos óseos mandibulares, por tal motivo se decide realizar retirada de la placa existente, reacomodamiento de los segmentos óseos, colocación de injerto autólogo de cresta ilíaca y fijación. Se observó buena evolución posoperatoria. La repercusión estética y funcional, en un paciente joven con una deformidad posquirúrgica por trauma; motivó el planeamiento de una reconstrucción mandibular mediante placa rígida e injerto de creta ilíaca. El tratamiento de este caso constituyó un reto profesional por tratarse de una deformidad posquirúrgica provocada por un trauma de alta energía; pero el trabajo quirúrgico en equipo aseguró resultados satisfactorios.

El mixoma mandibular odontogénico, es un tumor de origen mesénquima y representa del 0.5 al 17.7 % de los tumores odontogénicos. Se ubica en el tercer lugar de acuerdo a la frecuencia de presentación. Es un tumor benigno, localmente agresivo y con tendencia a la recidiva, lo que condiciona su tratamiento. En el presente trabajo se describen dos casos clínicos con diagnóstico de mixoma mandibular: un paciente de 33 años y otro de 60. Los dos casos fueron tratados mediante la técnica de mandibulectomía segmentaria sin desarticulación, con margen de seguridad, según el protocolo del Prof. Dr. A. Pogrel, con placa de reconstrucción mandibular, por abordaje extra e intraoral y sin interposición de injerto en el primer tiempo quirúrgico. Se discuten las características del tumor mixoma mandibular y sus opciones terapéuticas en los dos casos clínicos