The Cheesecake Technique: A Layered Autologous Soft-Tissue Adjunct to Extended TMJ Prosthetic Reconstruction After Mandibular Ameloblastoma Resection.

INTRODUCTION: Extensive ameloblastoma involving the mandibular condylar region may create a combined skeletal, articular, and soft-tissue reconstructive challenge.

TECHNICAL NOTE: A 35-year-old woman with multicystic ameloblastoma underwent en bloc right mandibular resection and immediate patient-specific extended total TMJ replacement. The prosthesis formed the structural "base"; an autologous dermal-fat graft was adapted around it as the volumetric "cream layer"; and a calcium-activated autologous PRP-derived fibrin membrane was applied superficially as the "frosting layer." The dermal-fat graft was intended to obliterate dead space and provide peri-prosthetic soft-tissue volume. The fibrin membrane was used as a conformable autologous provisional matrix with two proposed adjunctive functions: to support healing of the intraoral mucosal incision and to create a local pro-reparative and pro-angiogenic interface over the dermal-fat graft that might favour its early revascularisation and survival. These biological effects are mechanistically plausible but cannot be demonstrated from a single case. Healing was uneventful, without infection, dehiscence, facial nerve impairment, or prosthetic exposure. Maximal mouth opening was 35 mm at 1 month and 40 mm at 6 months.

DISCUSSION: The Cheesecake Technique provided a feasible multilayer strategy for simultaneous skeletal reconstruction and peri-prosthetic soft-tissue management. The specific contribution of the PRP-derived membrane requires confirmation in comparative studies.