SURGICAL MANAGEMENT OF A GIANT MAXILLARY AMELOBLASTOMA USING NAVIGATIONGUIDED ENDOSCOPIC ASSISTANCE AND TITANIUM MESH RECONSTRUCTION COMBINED WITH A PEDICLED BUCCAL FAT PAD: NARRATIVE LITERATURE REVIEW SUPPORTED BY AN ILLUSTRATIVE CLINICAL CASE

Background:Maxillary ameloblastoma is an uncommon but locally aggressive odontogenic tumor that presents substantial surgical challenges because of its proximity to the maxillary sinus, nasal cavity, orbit, and other critical midfacial structures. Extensive tumors may require radical resection followed by complex skeletal and soft-tissue reconstruction. Contemporary surgical navigation and endoscopic visualization may improve intraoperative anatomical control, whereas titanium mesh and vascularized soft-tissue techniques can facilitate restoration of complex maxillary defects. Objective:To review the contemporary literature concerning the surgical management of extensive maxillary ameloblastoma, with particular emphasis on computer-assisted navigation, endoscopic assistance, titanium mesh reconstruction, and pedicled buccal fat pad reconstruction, and to illustrate the clinical application of this combined strategy through a representative case. Narrative Literature Review:A narrative review of the contemporary literature was performed using PubMed, Scopus, and Web of Science, focusing on maxillary ameloblastoma, navigation-assisted surgery, endoscopic resection, titanium mesh reconstruction, and buccal fat pad flap techniques. The review focused on the anatomical and oncological challenges of maxillary ameloblastoma, the potential role of computer-assisted intraoperative navigation and endoscopic visualization, and reconstructive strategies for complex postoperative defects. Illustrative Clinical Case:A 48-year-old man presented with a 1.5-year history of progressive right-sided facial asymmetry, swelling, mild pain, and ipsilateral nasal obstruction. Imaging demonstrated a 45 × 38 × 32 mm right maxillary lesion involving the alveolar process, maxillary sinus, and orbital floor. Histopathological examination confirmed follicular ameloblastoma. Three-dimensional virtual planning was performed before surgery. Tumor resection was subsequently carried out using intraoperative navigation combined with endoscopic visualization. The resulting skeletal defect was reconstructed using a pre-contoured three-dimensional titanium mesh and covered with a pedicled buccal fat pad flap. Clinical Outcome of the Illustrative Case:The operative duration was 210 minutes, with an estimated blood loss of approximately 180 mL. No intraoperative complications were reported. Postoperative imaging demonstrated satisfactory positioning of the reconstructive titanium mesh. During 12 months of follow-up, no clinically evident tumor recurrence, titanium mesh exposure, or infection was observed. Complete intraoral epithelialization of the exposed buccal fat pad was achieved within four weeks, with preservation of mastication, swallowing, speech, and satisfactory facial symmetry. Conclusions:The contemporary literature supports a multidisciplinary approach to extensive maxillary ameloblastoma in which precise tumor resection is combined with individualized reconstruction. The illustrative case demonstrates the practical integration of navigation-guided endoscopic surgery with titanium mesh reconstruction and pedicled buccal fat pad coverage. This combination may represent a useful reconstructive strategy for selected complex maxillary defects, although the favorable outcome of a single case cannot establish comparative efficacy or generalizability.