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Video

Head & Neck

(28) Bilateral Ameloblastoma as a Secondary Tumor in the Residual Mandible 30 Years After Fibular Reconstruction for Squamous Cell Carcinoma: A Rare Case Report

Thursday, September 18, 2025
2:30 PM - 4:00 PM EDT

    Poster Presenter(s)

  • Johannes C. Schunk, MD, DMD (he/him/his)

    Resident
    Federal Army Hospital Hamburg, Dept. of Oral and Maxillofacial Surgery
    Hamburg, Hamburg, Germany

    • Co-Author(s)

  • Florian Dudde, MD (he/him/his)

    Resident
    Federal Army Hospital Hamburg, Dept. of Oral and Maxillofacial Surgery
    Hamburg, Hamburg, Germany

    • Co-Author(s)

  • MG

    Manfred Giese, n/a

    Head of Department
    Federal Army Hospital Hamburg, Dept. of Oral and Maxillofacial Surgery
    Hamburg, Hamburg, Germany

  • OS

    Oliver Schuck, n/a

    Specialist
    Federal Army Hospital Hamburg, Dept. of Oral and Maxillofacial Surgery
    Hamburg, Hamburg, Germany

Disclosure(s):
Johannes C. Schunk: No financial relationships to disclose
Abstract:

Background: Ameloblastomas are locally invasive odontogenic tumors, primarily affecting the posterior mandible. The development of a secondary tumor in the form of bilateral ameloblastomas in the residual native mandible, 30 years after segmental resection and fibular reconstruction for squamous cell carcinoma, is an extreme rarity. This case highlights the long-term oncologic risks in patients with a history of mandibular reconstruction.

Case Report: A 90-year-old female presented with bilateral mandibular swellings in the remaining native bone, adjacent to a 30-year-old fibula transplant used for mandibular reconstruction following squamous cell carcinoma resection. Computed tomography and panoramic radiograph revealed two distinct radiolucent lesions in the adjacent mandibula (left mandibular angle/ramus, right mandibular body), with no involvement of the fibular graft. Histopathological examination confirmed bilateral multicystic ameloblastomas, representing a secondary tumor.
The patient underwent bilateral tumor resection, ensuring preservation of the fibular graft and mandibular reconstruction through reconstruction plates. Postoperative recovery was uneventful, and long-term follow-up was initiated due to the high recurrence risk and rare nature of secondary ameloblastomas in reconstructed mandibles.
Discussion and

Conclusion: This case represents a highly unusual occurrence of a secondary tumor in a previously oncologically treated mandible, distinct from recurrence of the initial carcinoma. It underscores the need for lifelong surveillance in patients with previous mandibular reconstruction and highlights potential risk factors for tumor development in structurally altered bone. The case raises important questions about the tumorigenic potential of irradiated and post-resection mandibular bone.