Secondary Ameloblastic Carcinoma With Craniofacial and Skull Base Invasion: En Bloc Resection and Dural...

Secondary ameloblastic carcinoma is a rare malignant odontogenic tumor arising through malignant transformation of a pre-existing ameloblastoma and may involve complex craniofacial compartments. When the skull base is involved, management requires integration of oncologic resection with reconstructive strategies that ensure durable intracranial-extracranial separation and structural stability.

A 27-year-old male with a 13-year history of recurrent mandibular ameloblastoma presented with extensive craniofacial progression involving the temporal bone, masticator and infratemporal spaces, orbit, parotid region, and skull base, with regional lymph node metastases. Radical en bloc craniofacial resection with modified radical neck dissection was performed, including focal dural excision to achieve margin control. Proximal vascular control was achieved through elective external carotid artery ligation, which substantially limited nearby ipsilateral recipient-vessel options for immediate free tissue transfer. Cranial base integrity was restored using multilayer vascularized pericranial-galeal reconstruction reinforced with a dural substitute. Adjuvant radiotherapy (72 Gy) was administered. At 42-month follow-up, the patient remains disease-free, with preserved functional status and stable craniofacial contour.

Adherence to foundational reconstructive principles-including vascularized tissue coverage and multilayer dural repair-is integral to radical craniofacial resection. In selected defects with constrained recipient-vessel options, regional vascularized reconstruction may provide durable intracranial protection and preserve functional outcomes.