Mandibular Reconstruction for Pediatric Patients

Castellón, L.; Jeréz, Daniel; Mayorga, J.; Gallego, Alejandra; Fuenzalida, C.; Laissle, G.

doi:10.1097/scs.0000000000004746

Cited by 11 publications

(11 citation statements)

References 16 publications

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“…Our study was limited by the low prevalence of pediatric mandibular lesions necessitating resection and reconstruction. Only 24 patients were located through our search, and the low number contained in our study population was consistent with previous studies on the subject 1,3,9–11,18,21,22,26 . Although our study detected statistical differences in the number of trips to the operating room for complications and early major complications between the high and low RI groups, it was underpowered to detect statistical significance when assessing for late major complications and minor complications.…”

Section: Discussionsupporting

confidence: 75%

“…Only 24 patients were located through our search, and the low number contained in our study population was consistent with previous studies on the subject. 1,3,[9][10][11]18,21,22,26 Although our study detected statistical differences in the number of trips to the operating room for complications and early major complications between the high and low RI groups, it was underpowered to detect statistical significance when assessing for late major complications and minor complications. Although the difference between the percentage of patients experiencing these adverse outcomes were high, 67% versus 42% for late major complications and 50% versus 25% for minor complications, post hoc power analysis demonstrated a sample size of 61 patients in each group would be required to detect significant change in these outcomes.…”

Section: Discussioncontrasting

confidence: 57%

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Establishing a Novel Treatment Algorithm for Pediatric Mandibular Tumor Reconstruction

Chan

Wlodarczyk

Wolfswinkel

et al. 2021

Journal of Craniofacial Surgery

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Introduction: Guidelines for pediatric mandibular reconstruction (PMR) are not well-established. One must consider the growing craniofacial skeleton, mixed dentition, long-term dental occlusion, need for secondary reconstruction, and speech development. The traditional guideline (bone defect > 5 cm) for use of vascularized bone grafts (VBG) is not applicable given the variation of pediatric mandibular size and growth. We seek to propose a novel algorithm for PMR. Materials and Methods: An Institutional Review Board approved retrospective review of patients who underwent PMR for tumor resections between 2005 and 2019 evaluated patients' demographics, complications, resection index (RI) (resection length to mandibular length), and surgical outcomes. Outcomes based on RI were analyzed to establish guidelines for VBG utilization.Results: Twenty-four patients underwent PMR at a mean age of 9.1 years (range: 1 -18). The mandibular defect (meanAE standard deviation) fornon-VBG (n ¼ 18) and VBG (n ¼ 6) was 6.6 AE 3.0 cm and 12.8 AE 4.3 cm, respectively. The VBG group had fewer return trips to the operating room (P ¼ 0.028) and fewer major complications (P ¼ 0.028). When non-VBG with RI > 32% were compared to <32%, there was statistically less returns to the operating room for complications and a lower rate of early (< 30 days) major complications. Discussion: Our algorithm proposes an RI cutoff of 32% for VBG use for PMR. Patients with a sizable soft tissue defect, previous chemotherapy and/or radiation, planned adjuvant chemotherapy and/or radiation therapy, or a history of failed non-VBG should undergo reconstruction using VBG.

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Section: Discussionsupporting

confidence: 75%

Section: Discussioncontrasting

confidence: 57%

Establishing a Novel Treatment Algorithm for Pediatric Mandibular Tumor Reconstruction

Chan

Wlodarczyk

Wolfswinkel

et al. 2021

Journal of Craniofacial Surgery

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“…8 This suggests that free flap reconstruction may be performed successfully in pediatric patients, with minimal risk of free flap failure. 2,8,13 Unlike the study by Liu which reports outcomes for fasciocutaneous and osteocutaeous flaps in the pediatric population, our study reports flap outcomes for fibula flaps with specific outcomes for fibula donor site complications. 8 Additionally, our study uniquely reports outcomes on long-term craniofacial growth.…”

Section: Discussionmentioning

confidence: 93%

“…Prior studies suggest that reconstructed hemimandibulectomy defects undergo growth over time with minimal asymmetry and are facilitated by the preservation of the mandible epiphyseal growth plates and condyle. 2,4,9,21,23,24 Furthermore, a study by Temiz in 2015 demonstrated pediatric patients experienced normal facial symmetry and growth following mandibular defect reconstruction with fibula flaps, suggesting fibula flaps grow with patients' mandibles over time. 5,25 The results of this study are limited by the number of patients available for inclusion.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Survival and infection rates of microvascular free flaps in pediatric mandibular reconstruction: A systematic review and meta‐analysis

Huang,

Benour,

Wong Riff

2024

Microsurgery

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BackgroundVascularized free tissue transfer has been established as an effective method in the reconstruction of mandibular defects. However, a limited understanding of its efficacy in pediatric patients persists due to its infrequent presentation. The aim of this study is to systematically consolidate the survival and infection rates of free flaps in pediatric mandibular reconstruction.MethodsA systematic literature search was conducted on Ovid Medline, Embase, and Cochrane Library for studies published up to January 2024. We included peer‐reviewed studies reporting on survival and infection outcomes associated with free flap mandibular reconstruction in pediatric patients (<18 years). We performed a random‐effects meta‐analysis with the inverse‐variance weighted approach to estimate survival and infection rates. Heterogeneity was assessed by I2, and publication bias was examined using Egger's test.ResultsA total of 26 studies, reporting on 463 free flaps and 439 pediatric patients with a mean age of 10.7 years, were included in our study. Most free flaps originated from the fibula (n = 392/463, 84.7%) and benign tumors were the most common cause for mandibular reconstruction (n = 179/463, 38.7%). The pooled estimate for survival of flaps was 96% (95% CI: 93–97, I2 = 0%), and recipient‐site infections were estimated to occur in 9% (95% CI: 6–13, I2 = 0%) of cases. The most common reported complications within the study timeframe were early malocclusion (n = 28/123, 21.4%) and bite abnormalities (18/131, 13.7%).ConclusionFree tissue transfer for mandibular reconstruction in pediatric patients is effective and safe. Further research is required to explore functionality following mandibular reconstruction in diverse pediatric populations.

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Mandibular Reconstruction for Pediatric Patients

Cited by 11 publications

References 16 publications

Establishing a Novel Treatment Algorithm for Pediatric Mandibular Tumor Reconstruction

Establishing a Novel Treatment Algorithm for Pediatric Mandibular Tumor Reconstruction

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

Survival and infection rates of microvascular free flaps in pediatric mandibular reconstruction: A systematic review and meta‐analysis

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