CAD-CAM planned double free flap reconstruction of the paediatric mandible after Ewing sarcoma resection

Busser, Renee De; Kerckhoven, Liza Van; Vranckx, Jan

doi:10.1016/j.bjps.2020.12.070

Cited by 3 publications

(7 citation statements)

References 4 publications

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“…Most patients underwent immediate free flap reconstruction of defects following facial lesion resection. The facial artery and vein were most frequently used for free flap anastomosis in pediatric patients, which reflects previously reported common practices, most likely due to ease of dissection and consistent availability of vessels 3,6,8,9 …”

Section: Discussionsupporting

confidence: 52%

“…The facial artery and vein were most frequently used for free flap anastomosis in pediatric patients, which reflects previously reported common practices, most likely due to ease of dissection and consistent availability of vessels. 3,6,8,9 Closing osteotomies were required in most patients in our study for optimal reconstruction. No complications from closing osteotomies were reported, which is consistent with the adult literature showing osteotomies do not contribute to complications in fibula flaps.…”

Section: Discussionmentioning

confidence: 88%

“…Surgical resection of benign or malignant tumors resulting in maxillary and mandibular defects is rare in the pediatric population. [1][2][3][4][5] Multiple options for reconstruction are available for such defects, including local tissue reconstruction, placement of an oral obturator, and autologous free tissue transfer. 6 The paradigm for treatment in the adult population is well-defined with autologous composite free tissue transfer that replaces the composite tissue defect.…”

Section: Introductionmentioning

confidence: 99%

“…Surgical resection of benign or malignant tumors resulting in maxillary and mandibular defects is rare in the pediatric population 1–5 . Multiple options for reconstruction are available for such defects, including local tissue reconstruction, placement of an oral obturator, and autologous free tissue transfer 6 .…”

Section: Introductionmentioning

confidence: 99%

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Post‐operative Outcomes in Pediatric Patients Following Facial Reconstruction With Fibula Free Flaps

et al. 2022

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Educational Objective Assess outcomes of pediatric facial reconstruction with fibula free flaps. Objectives Free flap reconstruction of complex maxillofacial defects in pediatric patients is rare. Post‐operative complications, donor site morbidity, impact on craniofacial growth, and oro‐dental rehabilitation are unknown. Our study assesses the outcomes of pediatric maxillofacial reconstruction with composite fibula free flaps. Study Design Retrospective chart review. Methods Multi‐institutional retrospective chart review from 2000 to 2020 on pediatric patients undergoing maxillomandibular reconstruction with fibula free flaps. Results Eighty‐seven patients underwent 89 surgeries; 5 maxillary and 84 mandibular defects. Median age: 12 years. Defects were acquired following resection of sarcoma/carcinoma 44% or benign tumors 50%. 73% of cases had immediate free flap reconstruction. Closing osteotomies were reported in 74%; 1 in 40%, 2 in 27%, and more than 2 in 6.7%. Hardware was used in 98% and removed in 25%. 9.2% demonstrated long‐term hardware exposure, greater than 3 months following reconstruction. Short‐term complications: wound infection 6.7%, flap salvage/failure 2.2%, fistula 1.1%, and compromised craniofacial growth: 23%. Two patients developed trismus. Long‐term fibula donor site complications: hypertrophic scarring: 3.4%, dysesthesia: 1.1%, and long‐term gait abnormality: 1.1%. Dental rehabilitation was performed in 33%. Post‐operative speech outcomes showed 94% with fully intelligible speech. Conclusion Pediatric maxillary and mandible defects repaired with fibula free flaps demonstrated complication rates comparable to the adult free flap population. Long‐term follow‐up did not demonstrate adverse outcomes for craniofacial growth. Hardware for flap retention was utilized and remained in place with minimal exposure. Post‐operative gait abnormality is rare. Level of Evidence 3 Laryngoscope, 133:302–306, 2023

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Post‐operative Outcomes in Pediatric Patients Following Facial Reconstruction With Fibula Free Flaps

et al. 2022

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“…A 6-year-old patient had a Ewing sarcoma that was successfully restored with a double osteocutaneous fibula flap for the bony contour of the jaw and intraoral lining and a deepithelialized anterolateral thigh flap for soft-tissue volume of the cheek after resection. 25 One 13-year-old had an osteocutaneous fibula flap after resection of a rhabdomyosarcoma. A revision of the venous anastomosis was successful.…”

Section: Complicationsmentioning

confidence: 99%

“Maxillo-mandibular reconstruction with vascularized bone flaps using insourced virtual surgical planning and home-made CAD-CAM: A 5-year single-center evolution in 75 patients.”

Vranckx

Desmet

Bila

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Virtual surgical planning (VSP) and computer-aided design and manufacturing (CAD/CAM) of surgical guides and jigs have dramatically changed the predictability of bony reconstruction of the jaw. VSP craftsmanship can lead to precision and enables the surgeon to complement the donor bone osteotomies with bony resection of the jaw. In recent years, immediate dental rehabilitation has become an integral part of VSP. However, outsourced CAD/CAM technology is expensive and may not be an option for many institutions worldwide. Methods: The authors present here a consecutive series of 75 maxillofacial reconstructions from 2015 to 2020. We established an insourced “in-house” protocol for VSP and “home-made” CAD/CAM for the reconstruction of maxilla-mandibular defects with fibula, iliac crest, and scapular angle flaps. All patient files were analyzed retrospectively, and relevant parameters influencing the reconstructive outcome were determined. Results: The authors went from a fibula-based protocol toward the selection of optimal vascularized bone for immediate placement of osteointegrated implants. Bone flap survival was 94.7% after 4 months. The 3-year patient survival is 77.6%. The authors show the multiple steps required for the routine use of in-house CAD/CAM and report the related financial balance. Conclusions: Insourced VSP and CAD/CAM has evolved into a valuable strategy in maxillomandibular reconstruction that promotes accuracy and precision and allows for occlusion-based planning with quality-of-life and aesthetic outcomes as essential parts of the reconstruction even in high-level oral cancers. Further reductions in the hardware and software acquisition costs may lead to widespread implementation of this innovative technology. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Treatment of mandibular Ewing’s sarcoma in a child: A rare case and literature review

Nakai

Matsuki

et al. 2023

Journal of Oral and Maxillofacial Surgery, Medicine, and Pathol

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CAD-CAM planned double free flap reconstruction of the paediatric mandible after Ewing sarcoma resection

Cited by 3 publications

References 4 publications

Post‐operative Outcomes in Pediatric Patients Following Facial Reconstruction With Fibula Free Flaps

Post‐operative Outcomes in Pediatric Patients Following Facial Reconstruction With Fibula Free Flaps

“Maxillo-mandibular reconstruction with vascularized bone flaps using insourced virtual surgical planning and home-made CAD-CAM: A 5-year single-center evolution in 75 patients.”

Treatment of mandibular Ewing’s sarcoma in a child: A rare case and literature review

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