Mandibulektomi segmental dengan rekonstruksi cangkok tulang fibula non-vaskularisasi pada pasien ameloblastoma tipe folikuler  Segmental mandibulectomy with non-vascularised fibular bone graft reconstruction in follicular ameloblastoma patient

Rumartha Putri Swari; Arfan Badeges; Vera Julia

doi:10.24198/jkg.v32i3.31485

Mandibulektomi segmental dengan rekonstruksi cangkok tulang fibula non-vaskularisasi pada pasien ameloblastoma tipe folikuler
Segmental mandibulectomy with non-vascularised fibular bone graft reconstruction in follicular ameloblastoma patient

Rumartha Putri Swari, Arfan Badeges, Vera Julia

Abstract

Pendahuluan: Ameloblastoma adalah tumor invasif lokal dengan insidensi kekambuhan yang tinggi jika tidak dieksisi sepenuhnya. Mandibulektomi segmental sebagai pilihan tatalaksana yang dapat menyebabkan deformitas dan asimetri pada wajah, serta masalah pengunyahan. Pemulihan defek setelah reseksi mandibula menimbulkan masalah yang cukup berat. Tujuan laporan kasus ini untuk melaporkan hasil rekontruksi menggunakan cangkok tulang non-vaskularisasi mandibulektomi segmental pada pasien dengan ameloblastoma mandibula. Laporan kasus: Pria berusia 33 tahun datang ke Poliklinik Rawat Jalan Bagian Bedah Mulut dan Maksilofasial RS Persahabatan dengan keluhan utama pembengkakan mandibula yang perlahan bertambah dan tidak nyeri sejak enam tahun lalu. Pemeriksaan ekstra oral tampak asimetri wajah, bukaan mulut tidak ada limitasi, tidak teraba pembesaran kelenjar getah bening regio leher. Pemeriksaan intraoral didapatkan adanya benjolan regio mandibula kiri dengan batas tegas, konsistensi padat, permukaan tampak trauma oklusi gigi antagonis, immobile, dan terdapat nyeri tekan. Gambaran radiologis menunjukan lesi radiolusen multilokuler menyerupai honeycomb pada corpus mandibula kiri meluas ke regio ramus mandibula kiri. Pemeriksaan biopsi menunjukkan hasil ameloblastoma tipe folikuler pada mandibula kiri dan dilakukan mandibulektomi segmental dengan rekonstruksi cangkok tulang fibula non-vaskularisasi. Sembilan bulan setelah operasi, cangkok tulang non-vaskularisasi tidak menunjukkan komplikasi intraoral dengan bekas luka submandibular ekstraoral baik. Simpulan: Cangkok tulang fibula non-vaskular dapat dipertimbangkan sebagai salah satu pilihan untuk rekonstruksi setelah mandibulektomi segmental pada pasien ameloblastoma.

Kata kunci: Mandibulektomi segmental, cangkok fibula non-vaskularisasi, ameloblastoma folikuler.

ABSTRACT

Introduction: Ameloblastoma is a locally invasive tumour with a high incidence of recurrence if not completely excised. Segmental mandibulectomy as a treatment option that can cause facial deformities and asymmetry and mastication problem. Recovery of the defect after mandibular resection presents a severe problem. This case report was aimed to report the results of reconstruction using a segmental non-vascularised mandibulectomy bone graft in a patient with mandibular ameloblastoma. Case report: A 33-year-old male came to the Outpatient Polyclinic of the Oral and Maxillofacial Surgery Division of Persahabatan General Hospital with the chief complaint of mandibular inflammation, which was slowly increasing yet painless since six years prior. Extraoral examination showed facial asymmetry, no limitation in mouth opening, no palpable enlargement of lymph nodes in the neck region. Intraoral examination revealed a lump in the left mandibular region with firm borders, solid consistency. The surface appears to be traumatic occlusion of the antagonist tooth, immobile, and tenderness was found. Radiological features showed a multilocular, honeycomb-like radiolucent lesion on the left mandibular body extending into the left mandibular ramus region. A biopsy showed follicular ameloblastoma in the left mandible, and a segmental mandibulectomy was performed with non-vascular fibular bone graft reconstruction. Nine months after surgery, non-vascular bone grafts showed no intraoral complications with either extraoral submandibular scar. Conclusion: Non-vascular fibular bone graft can be considered an option for reconstruction after segmental mandibulectomy in ameloblastoma patients.

Keywords: Segmental mandibulectomy, non-vascularised fibula graft, follicular ameloblastoma.

Keywords

mandibulektomi segmental; cangkok fibula non-vaskularisasi; ameloblastoma folikuler; segmental mandibulectomy; non-vascularised fibula graft; follicular ameloblastoma

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DOI: https://doi.org/10.24198/jkg.v32i3.31485