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1.
Diagn Cytopathol ; 2022 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-35077030

RESUMO

Ameloblastomas are benign but locally aggressive odontogenic tumors that commonly present as expansile lesions in the tooth-bearing areas. Fine-needle aspiration (FNA) biopsies of ameloblastomas are rare in clinical practice, and only a handful of case reports and series have described their cytologic features. We present the case of a 70-year-old woman with a large and disfiguring maxillary sinus soft tissue mass sampled via transcutaneous FNA. Aspirate smears were composed of small clusters of cohesive and monotonous basaloid cells. The accompanying cellblock showed similar clusters of basaloid cells in gland-like, or "adenoid," configurations, eliciting a differential diagnosis that included sinonasal and salivary gland neoplasms. Excisional surgery material was consistent with ameloblastoma with adenoid morphology. Next-generation sequencing (NGS) analysis demonstrated FGFR2 and SMO pathogenic variants. This case exemplifies several uncommonly described features of ameloblastomas in cytology, including cyto-histologic correlation, adenoid morphology, and NGS findings. Awareness of the cytologic features of this neoplasm are important for cytopathologists confronted with maxillary sinus lesions.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34998647

RESUMO

The correlation between BRAF mutation and the aggressiveness of ameloblastoma remains controversial. The aim of this study was to investigate the association of BRAF V600E expression with clinicopathological features and disease-free survival (DFS) in patients with ameloblastoma. Seventy-four conventional ameloblastoma samples were collected. Immunohistochemistry using anti-BRAF V600E antibody was performed on formalin-fixed, paraffin-embedded tissue sections. Clinicopathological characteristics and treatment outcomes were retrieved from the patient medical records. BRAF V600E immunoreactivity was detected in 50/74 cases (67.6%); 39 were strongly positive and 11 weakly. There was a significant difference in BRAF V600E expression between ameloblastoma and dental follicle (P = 0.034). However, there was no significant association of BRAF V600E expression with any clinicopathological features, including sex, age, location, duration, tumour size, radiographic appearance, cortical perforation, recurrence, and histological subtype. DFS analysis revealed that patients with BRAF-mutated ameloblastoma had a shorter median survival time (84 months vs 168 months) and lower 5-year survival rate (59% vs 67%) compared to the BRAF wild-type group; however, this was not statistically significant (P = 0.169). Moreover, logistic regression analysis revealed that treatment with enucleation was an independent risk factor for tumour recurrence (odds ratio 9.236; P = 0.028). This study demonstrated that the BRAF V600E mutation was not associated with any clinicopathological features of ameloblastoma. A trend towards earlier recurrence in tumours with BRAF mutation was observed, but this requires further investigation. Furthermore, the findings suggest that the treatment modality is an important factor in determining recurrence in ameloblastoma despite genetic alterations.

5.
Int J Surg Pathol ; : 10668969211064203, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-34994576

RESUMO

Background and aim: Ameloblastoma is a benign, intraosseous, progressively growing, epithelial, odontogenic neoplasm. BRAF and SMO mutations have been reported in ameloblastoma. In this study, we evaluated BRAF V600E and SMO L412F mutations; and assessed the relationship between BRAF V600E mutant expression and the clinicopathological features in Japanese patients with ameloblastoma. Methods: We examined 24 formalin-fixed paraffin-embedded samples. All specimens were from patients with mandibular ameloblastoma: 20 were conventional ameloblastoma and 4 were unicystic ameloblastoma. The BRAF V600E mutation was assessed by Sanger sequencing and immunohistochemistry, and the SMO L412F mutation was assessed only by Sanger sequencing. Results: Twenty of the 24 (83%) ameloblastoma samples carried the BRAF V600E mutation; 22 of the 24 (92%) samples were immunohistochemically positive for BRAF V600E. However, the SMO L412F mutation was not detected in any of them. The BRAF V600E mutation status did not correlate with the clinicopathological features, such as age, sex, location, method, recurrence, and subtype. Conclusion: BRAF inhibitors could be a potential treatment option for Japanese patients with ameloblastoma, harboring the BRAF V600E mutation.

6.
Artigo em Inglês | MEDLINE | ID: mdl-35017129

RESUMO

INTRODUCTION: This meta-analysis provides reliable data on the prevalence of unicystic ameloblastomas (UA's) among solid/multicystic ameloblastomas (SMA's), as well the ratio of their presence in the maxilla and mandible and in the tooth-bearing area versus the posterior regions of the mandible, including the third molar region and ascending ramus. MATERIAL AND METHODS: A systematic review and meta-analysis was performed according to PRISMA guideline using the strategy ((unicystic ameloblastoma) OR (((ameloblastoma) OR (solid ameloblastoma)) OR (multicystic ameloblastoma))) NOT ((((systematic review) OR (literature review)) OR (case report)) OR (Immunohistochemical)). DISCUSSION: The study included 3856 SMA's and 1537 UA's, which amounted to 28.5% UA's. Of the 380 cases of UA from twelve articles that mentioned the involved jaws, 355 were in the mandible and 25 in the maxilla. The preponderance for the mandible is much higher than reports from previous studies of smaller series. Only five articles mentioned the location within the mandible. The vast majority was in the posterior area. CONCLUSION: The consequences for treatment were discussed, with an emphasis on the approach to unicystic lesions in the posterior part of the mandible for which a protocol is suggested.

7.
Pak J Med Sci ; 38(1): 207-213, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35035427

RESUMO

Background & Objective: Ameloblastomas have been analyzed histologically for diagnostics and its sub-classification; however, the analysis carried out so far does not provide any authentic evidence regarding prognosis of Ameloblastoma. Subject categorization is still a topic of debate. The purpose of this study was to determine the immuno-expression of markers such as MMP-9 and E-Cadherin in different sub-types of ameloblastoma and establish their correlation with histological variants. Methods: Analytical study of 71 cases of ameloblastoma was conducted in AFIP Rawalpindi, between January to June, 2019. Samples were taken from different intraoral sites including the patients with tumor of ameloblast. The tumor was sub classified histologically on the basis of WHO classification. 'Chi Square' Test was applied to find the association of MMP-9 and E-Cadherin with histological variants of ameloblastoma. P-value ≤ 0.05 were found statistically significant. Results: On histopathological sub-classification, 52.1% were diagnosed as follicular type, 23.9% were plexiform type, 14.1% were Acanthomatous type and 9.9% were of unicystic ameloblastoma. 80% of the total Acanthomatous type and 59% of the total plexiform had strong immuno-expression, which was significantly different from follicular type MMP-9 (p ≤ 0.05). All cases of unicystic ameloblastoma and 67.6% of follicular type showed strong immuno-expression significantly different from 20% of Acanthomatous type and 59% of plexiform type E-Cadherin (p ≥ 0.05). On the other hand, when statistical analysis was carried out, an inverse relation between MMP-9 and E-cadherin was observed. Conclusion: The effect of MMP-9 and E-cadherin in ameloblastoma is aggressive in nature and effectiveness was seen in subtypes of ameloblastoma.

8.
Clin Case Rep ; 10(1): e05241, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35079382

RESUMO

Unicystic ameloblastoma (UAM) in the pediatric population is a rare clinical entity that has not been well addressed in the literature. Radical approaches affect a growing young patient's physical and psychological development, so conservative approaches are widely used for management in children. This report describes the case of a 9-year-old girl with UAM of the mandible, which also involved the impaction of the first and second premolars. Marsupialization with orthodontic treatment was performed to shrink the lesion and upright the first premolar involved in the tumor. Ten months after marsupialization, the lesion had healed entirely. The combination of conservative surgery and orthodontic treatment effectively shrank the lesion, preserving mandibular growth, preserving the involved first and second premolars, and promoting the eruption of the teeth.

9.
J Pers Med ; 12(1)2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-35055392

RESUMO

Ameloblastoma is the most common benign odontogenic neoplasm, but with an aggressive behavior and a high recurrence rate. Nowadays wide surgical resection is the current recommended treatment, which can cause further loss of function and esthetics. Recent studies point to the stem/progenitor cells as both initiators and propagators of the tumors. Elucidation of the cellular and molecular mechanisms underlying the tumor stem cells is of broad interest for understanding tumorigenesis and for developing effective targeted therapies. SRY related HMG box gene 2 (SOX2) is a transcription factor that plays important roles in development, stem cell renewal, and cancer formation. Few studies have revealed increased SOX2 expression in atypical ameloblastoma and ameloblastic carcinoma. For the development of personalized medicine for ameloblastoma, biomarkers that provide prognostic or predictive information regarding a tumor's nature or its response to treatment are essential. Thus, in this study, we aimed to study if SOX2-positive cells exist in ameloblastomas and their correlation with the clinicopathologic parameters. Our data suggested BRAF(V600E) mutation might contribute to the expansion of SOX2-positive cells. The identification of BRAF(V600E) mutation and the amplification of SOX2-positive cells in ameloblastomas imply the possible benefit of applying BRAF and SOX2 inhibitors in recurrent and un-resectable ameloblastomas.

10.
Int J Surg Case Rep ; 90: 106676, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34954627

RESUMO

INTRODUCTION AND IMPORTANCE: Cemento ossifying fibroma (COF) is an encapsulated lesion that is often found in the mandible of middle-aged females. Cystic degeneration may be associated to several osseous lesion. This particular presentation is not well documented in the jaws. CASE PRESENTATION: Patient presented was referred to oral surgery department for abnormal radiolucency in the right mandible on panoramic X-ray. The patient did not have any specific medical history and reported painful areas in right mandibular region. During diagnosis assessment, ameloblastoma was first considered due to the presence of cystic lesion clusters. But the mixed image in previous X-ray pointed to a fibro-osseous with a change in pathogenesis pathway. Diagnosis buildup was based on previous radiographs, incisional biopsy was proposed to identify the histopathological feature of the lesion before proceeding to further investigation (CBCT) or treatments (decompression or enucleation). COF of the jaws associated to non-specific cystic changes was the histopathological diagnosis. Delay in treatment showed an unexpected outcome with good clinical and bone healing. CLINICAL DISCUSSION AND CONCLUSION: This case shows the importance of previous radiographs, when available, in diagnosis buildup. The fibro-osseous lesion with cystic change may show a good biological response with conservative management. A clinical and radiological surveillance after a conservative treatment may be a better option in treatment of these lesions.

11.
Dentomaxillofac Radiol ; 51(1): 20210212, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34133226

RESUMO

OBJECTIVES: This study aimed to determine the discrimination power of apparent diffusion coefficient (ADC) for cystic lesions in the jaw using MRI. METHODS: We selected 127 cystic lesions, comprising dentigerous cysts (DCs), odontogenic keratocysts (OKCs), and unicystic ameloblastomas (UABs), from our MRI database examined by 3T MRI, including diffusion-weighted imaging sequences, and we reviewed their imaging characteristics. We attempted to discriminate the three types of lesions by ADC values with receiver operator characteristic analysis; however, satisfactory results were not obtained for differentiation between DC and OKC. Therefore, we performed a decision tree analysis. RESULTS: The imaging characteristics of the lesions were significantly different according to Fisher's exact test, except for differences in sex. The ADC values statistically discriminated the lesions of DC and UAB, OKC and UAB, but not DC and OKC. Thus, differentiation was performed by a decision tree for DC and OKC by evaluating the following points: the attached tooth condition, signal intensity on the T1 weighted image (T1SI), ADC value, and the cyst site. However, cases showing hypo- or isointense T1SI with an ADC value under 1.168 × 10-3 mm2/s were difficult to differentiate. CONCLUSION: The ADC value helped distinguish UAB from both DC and OKC, but not DC from OKC. However, the decision tree based on ADC value, tooth contact status, and T1SI helped differentiate DC and OKC to some extent.


Assuntos
Ameloblastoma , Cistos Odontogênicos , Tumores Odontogênicos , Imagem de Difusão por Ressonância Magnética , Humanos , Imageamento por Ressonância Magnética , Cistos Odontogênicos/diagnóstico por imagem
12.
Case Rep Oncol Med ; 2021: 9945591, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34877023

RESUMO

Synovial sarcoma (SS) is a rare malignant mesenchymal tumor that mainly occurs in body extremities, being uncommon in the head and neck region. In the present study, we described a case of primary intraosseous SS arising in the mandible of a 22-year-old young male. The patient reported a painful swelling on the left side of the mandible for the last 7 months. Imaging exams showed the presence of an expansive and multilocular radiolucent lesion, extending from the left condyle to the mandibular body. The clinic diagnostic hypotheses were ameloblastoma or malignant neoplasm. Histologically, the lesion was characterized by a proliferation of spindle cells exhibiting vesicular nuclei and evident nucleolus. Neoplastic cells were positive for AE1/AE3, cytokeratin 7, vimentin, CD-99, and TLE-1 and negative for CD-34, S-100, SMA, and HHF-35. A combination of clinical, histologic, and immunohistochemical characteristics supported the diagnosis of SS. The patient was referred for treatment, and preoperative exams did not reveal any other tumor foci in the body of the patient. The final diagnosis was of a primary intraosseous SS of the mandible.

13.
Braz. j. oral sci ; 20: e211817, jan.-dez. 2021. tab
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1253160

RESUMO

Tumors of the maxillomandibular complex are a heterogeneous group of lesions with a wide spectrum of clinical and histopathological characteristics. Aim: To evaluate the prevalence of odontogenic and non-odontogenic tumors associated with maxillary bones in a Reference Center for Oral Lesions. Methods: A cross-sectional study based on the medical records of a Reference Center for Oral Lesions at the State University of Feira de Santana, from 2006 to 2018. The data was initially analyzed in a descriptive manner. For bivariate analysis, Pearson's chi-square test was applied. The level of significance was set at 5%, where p≤ 0.05 is considered significant. Results: The prevalence of tumors was 2.27%. The average age of the individuals was 22.2 (± 15.1) years, the majority being up to 39 years (79.59%) and female (69.40%). A statistically significant difference was observed in relation to age (p = 0.00), as well as regarding the location of tumors in the anterior or posterior region (p = 0.02). Odontogenic tumors were benign, with odontoma being most frequent (46.90%), followed by ameloblastoma (16.30%). As for the non-odontogenic, neurofibroma (4.10%) and osteoma (4.10%) were the most common across the benign, while osteosarcoma accounted for 6.10% of cases. Conclusion: Odontogenic tumors were the most frequent in women, with age up to 39 years, odontoma being most common in the posterior region of the mandible. Among nonodontogenic tumors, central neurofibroma and osteoma were the most common. Osteosarcoma was more frequent in men over 40 years old and in the mandible region


Assuntos
Patologia Bucal , Neoplasias Maxilomandibulares/epidemiologia , Estudos Transversais , Diagnóstico
15.
Sci Rep ; 11(1): 24088, 2021 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-34916549

RESUMO

Ameloblastoma is a benign, epithelial cancer of the jawbone, which causes bone resorption and disfigurement to patients affected. The interaction of ameloblastoma with its tumour stroma drives invasion and progression. We used stiff collagen matrices to engineer active bone forming stroma, to probe the interaction of ameloblastoma with its native tumour bone microenvironment. This bone-stroma was assessed by nano-CT, transmission electron microscopy (TEM), Raman spectroscopy and gene analysis. Furthermore, we investigated gene correlation between bone forming 3D bone stroma and ameloblastoma introduced 3D bone stroma. Ameloblastoma cells increased expression of MMP-2 and -9 and RANK temporally in 3D compared to 2D. Our 3D biomimetic model formed bone nodules of an average surface area of 0.1 mm2 and average height of 92.37 [Formula: see text] 7.96 µm over 21 days. We demonstrate a woven bone phenotype with distinct mineral and matrix components and increased expression of bone formation genes in our engineered bone. Introducing ameloblastoma to the bone stroma, completely inhibited bone formation, in a spatially specific manner. Multivariate gene analysis showed that ameloblastoma cells downregulate bone formation genes such as RUNX2. Through the development of a comprehensive bone stroma, we show that an ameloblastoma tumour mass prevents osteoblasts from forming new bone nodules and severely restricted the growth of existing bone nodules. We have identified potential pathways for this inhibition. More critically, we present novel findings on the interaction of stromal osteoblasts with ameloblastoma.

16.
Sci Rep ; 11(1): 23853, 2021 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-34903811

RESUMO

This study has analyzed 41 patients with mandibular ameloblastoma who underwent a partial mandibulectomy and reconstruction by folding the free fibular flap. In the preoperative and postoperative (6 months and 24 months after surgery), the Quality of Life (QOL) of these patients was assessed by using the University of Washington Quality of Life Questionnaire (UW-QOL) and the medical outcome study short form-36 (SF-36) questionnaires. SPSS 20.0 statistical software was used to conduct statistical analysis on the base data of the two groups of patients. Independent sample t test was conducted for sf-36 and UW-QOL scores at two time points in each group. The SF-36 survey showed that body pain (54.54 ± 8.10), general health (55.27 ± 7.54), and health changes (58.29 ± 9.60) decreased significantly at 6 months after surgery, but the mean score at 24 months after surgery all exceeded the preoperational level. At 24 months after the surgery, the vitality (80.41 ± 3.74), social function (81.61 ± 4.07), emotional role (82.39 ± 4.07), psychological health (81.66 ± 4.37) and total score (704.00 ± 31.53) all returned to the preoperative level, which was statistically significant compared with 6 months after surgery. However, there was no significant difference compared with the preoperative level. The UW-QOL survey showed that chewing (56.68 ± 7.23), speech (54.54 ± 7.7) and taste (62.29 ± 10.15) have significantly changed at 6 months after the surgery, and the difference was statistically significant at 24 months after surgery. Saliva generation decreased slightly (80.76 ± 3.35) at 6 months after surgery, but quickly returned to the preoperative level (81.59 ± 4.06). The total score of the patients almost recovered to the preoperative level at 24 months after surgery. The folded the fibular flap can not only repair the defects of soft tissue and bone tissue, but also restore the height of the alveolar ridge to, avoid the imbalance of crown and root ratio after implantation and reduce the occurrence of peri-implant inflammation, so that a true functional reconstruction can be realized.

17.
Stomatologiia (Mosk) ; 100(6): 44-49, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34953188

RESUMO

OBJECTIVE: Development of a method for reconstruction of the inferior alveolar nerve and evaluation of its effectiveness in resection of the lower jaw for benign tumors. MATERIAL AND METHODS: In the period from 2018 to 2020, 10 resections were performed for benign odontogenic neoplasms (myxoma, ameloblastoma, osteoblastoclastoma) at the age of 18 to 60 years. Tactile, pain and temperature sensitivity were subjectively studied. The assessment of subjective sensitivity was carried out five times: before the operation, after 21 days, after 3.6 months and a year after the operation, an electromyograph «SYNAPSIS¼ was used for an objective assessment of sensitivity. The studies were conducted twice: 21 days after the operation and 12 months later. Reinervation was carried out by two methods. Method I: by transferring the insertion from the calf nerve and applying end-to-end neuroanastomoses between the proximal and distal ends of the inferior alveolar nerve (5 patients); method II: transferring the insertion from the calf nerve to the lingual nerve. Neuroanastomoses are applied periepineurally between the distal end of the inferior alveolar nerve and the lingual nerve «end to side¼ (5 patients). RESULTS: After 12 months, all types of sensitivity were restored in the control group in all patients, and in the second group in 80%. All patients had areas of hyposthesia in terms of temperature and tactile sensitivity. The results of trigeminal evoked potentials were negative in all patients 21 days after surgery, and peaks of evoked potentials were recorded in 9 (90%) patients 12 months later. CONCLUSION: These reconstruction techniques are effective both when the proximal end of the inferior alveolar nerve is preserved, and when it is impossible to preserve it. With minimal donor damage, the sensitivity of the lower lip is restored, which significantly improves the quality of life of patients and their social adaptation.


Assuntos
Ameloblastoma , Qualidade de Vida , Adolescente , Adulto , Humanos , Nervo Lingual , Mandíbula/cirurgia , Nervo Mandibular/cirurgia , Pessoa de Meia-Idade , Adulto Jovem
18.
BMJ Case Rep ; 14(12)2021 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-34906959

RESUMO

Ameloblastic carcinoma is a rare malignant odontogenic neoplasm that exhibits diverse clinical and radiological presentations. In fact there are several differential diagnoses during histopathological evaluation too. Lack of adequate reports could not establish the predominant demographic, clinical and radiological presentations. For the same reasons, the role of adjuvant radiotherapy and chemotherapy is also unsubstantiated yet. This case discusses the innocuous clinical and radiological presentation of ameloblastic carcinoma in a 55-year-old man where the diagnostic confirmation was achieved through histopathological evaluation. The differential diagnoses, treatment and follow-up details of this case are discussed in light of the previous published case reports and systematic reviews of case reports in an attempt to increase the sensitisation among dentists towards ameloblastic carcinoma.


Assuntos
Ameloblastoma , Carcinoma , Neoplasias Mandibulares , Tumores Odontogênicos , Ameloblastoma/diagnóstico por imagem , Ameloblastoma/terapia , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Mandibulares/terapia , Pessoa de Meia-Idade , Tumores Odontogênicos/diagnóstico
19.
Artigo em Inglês | MEDLINE | ID: mdl-34920910

RESUMO

The purpose of this study was to investigate whether ameloblastoma with a high likelihood of recurrence can be predicted using random forest model, a machine learning algorithm. Data were collected from patients treated for ameloblastoma between 1999 and 2019 at the University of Hong Kong. Fourteen clinical parameters were used to grow the decision trees to classify patients with or without ameloblastoma recurrence in the follow-up period. The random forest algorithm was computed 100 times in the training cohort (n = 100) and verified in the testing cohort (n = 50). The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used as the performance measurement of separability. One hundred and fifty patients (76 female, 74 male) were recruited, with a mean follow-up time of 103 months. Recurrence occurred in a total of 25 cases (16.7%) over the 20-year period. The AUC were calculated for the median and mean ROC curves; these were 0.777 and 0.825, respectively. The results showed that random forest model was able to predict recurrence of ameloblastoma with reliable accuracy. The four most important variables influencing ameloblastoma recurrence were the time elapsed from treatment, initial surgical treatment, tumour size, and radiographic presentation. This study provides insights into the detection of high-risk patient groups to monitor recurrence. Further application of random forest to other diseases could greatly benefit clinical decisions.

20.
Artigo em Inglês | MEDLINE | ID: mdl-34922900

RESUMO

After en bloc resection of the maxilla or mandible, surgeons may choose to replace the missing bone and soft tissue with a fibula free flap (FFF). One of the complications that may arise during the healing of an FFF is heterotopic ossification along the free flap pedicle. Heterotopic ossification is most often noted incidentally on postoperative radiographs and rarely creates a functional deficit. Subperiosteal dissection of the pedicle from the bone during the harvest of the FFF is believed to be the main contributing factor that leads to this formation of bone along the flap soft tissue. Pain or limitation of movement of the jaws, depending on where heterotopic bone forms, are related functional issues. Changes in facial appearance due to expansion related to this phenomenon of bone deposition may also occur. This paper presents a patient that developed a functional deficit secondary to heterotopic ossification of an FFF that required surgical intervention. The goal of our surgery is to maintain the blood supply to a vascularized flap while removing the heterotopic bone. We will present the unique aspects of planning this challenging surgery: CASE: A 40-year-old man with a history of right posterior maxillary ameloblastoma underwent a hemi-maxillectomy with FFF reconstruction. The patient developed extracapsular heterotopic bone ankylosis beginning 2 months postoperatively developing severe trismus and required surgical intervention. Radiographic imaging revealed extensive heterotopic ossification of the vascular pedicle that extended from the most proximal positioned end of the fibula to the inferior lateral border of the mandible. A radiographic computed tomography with contrast imaging revealed an intact vascular pedicle with surrounding heterotopic bone. Virtual planning and stereolithic modeling were utilized to plan the heterotopic bone removal. In the operating room, we removed the heterotopic bone in small segments according to the virtual plan to avoid injuring the vascular pedicle. A coronoidectomy was also performed to help gain more range of motion. An adipofascial flap using the buccal fat pad was raised into the area of defect to prevent future recurrence. The patient was put on a strict physical therapy regimen to help regain his range of motion. CONCLUSION: Heterotopic ossifications along free flap pedicles are a known complication of the FFF. A conservative management approach should be used since most postoperative patients will be asymptomatic and findings are incidental on postoperative imaging. Surgery should be reserved for symptomatic patients. Heterotopic ossification needs to be considered as a differential in a microvascular reconstruction postoperative patient when the patient presents with a slow onset of facial swelling, neck mass, or trismus. Virtual planning is an essential tool in the surgeon's planning armamentarium dependent on the timing of the procedure so that the vascular integrity of the flap can be protected after the initial anastomosis.

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