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Huang RS, Benour A, Wong Riff KWY. Survival and infection rates of microvascular free flaps in pediatric mandibular reconstruction: A systematic review and meta-analysis. Microsurgery 2024; 44:e31200. [PMID: 38828556 DOI: 10.1002/micr.31200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/08/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Vascularized 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. METHODS A 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. RESULTS A 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%). CONCLUSION Free 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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Affiliation(s)
- Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ali Benour
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland
| | - Karen W Y Wong Riff
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Liu S, Zhang WB, Wang Y, Mao C, Yu GY, Peng X. Long-Term Outcomes after Pediatric Mandibular Reconstruction Using Vascularized Free Fibula Flap. Plast Reconstr Surg 2024; 153:397e-406e. [PMID: 37053458 DOI: 10.1097/prs.0000000000010529] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the long-term outcomes of mandibular reconstruction with vascularized free fibula flap in pediatric patients. METHODS Consecutive cases of mandibular reconstruction with vascularized free fibula flaps in pediatric patients at Peking University School and Hospital of Stomatology between 1999 and 2019 were reviewed. Postoperative computed tomography (CT) data of all patients were collected at each postoperative follow-up point, and after the age of 18 years. The length and height of the grafted fibula and the length of the remaining mandible were evaluated by measuring the three-dimensional CT data using ProPlan CMF 3.0 software. Lower limb function was evaluated using the Enneking evaluation scale. Facial symmetry was self-evaluated and scored. Statistical analysis was performed on the data obtained. RESULTS Fourteen patients were included in this study. All flaps were successful. The CT measurement results showed growth in the length of the grafted fibula that reconstructed the mandibular ramus and the residual mandible ( P < 0.05). The height of the grafted fibula remained stable ( P > 0.05). Eight patients were followed up until they were older than 18 years, and the CT measurement results after 18 years showed an essentially symmetric mandible profile ( P > 0.05). All patients were satisfied with their postoperative facial symmetry. Enneking evaluation scores showed good recovery of lower limb functions. CONCLUSIONS The vascularized free fibula flap for mandibular reconstruction in pediatric patients is safe and reliable. It also provides good cosmetic and functional outcomes, as it demonstrated positive growth. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Shuo Liu
- From the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center of Stomatology; National Clinical Research Center for Oral Diseases; and National Engineering Laboratory for Digital and Material Technology of Stomatology
| | - Wen-Bo Zhang
- From the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center of Stomatology; National Clinical Research Center for Oral Diseases; and National Engineering Laboratory for Digital and Material Technology of Stomatology
| | - Yang Wang
- From the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center of Stomatology; National Clinical Research Center for Oral Diseases; and National Engineering Laboratory for Digital and Material Technology of Stomatology
| | - Chi Mao
- From the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center of Stomatology; National Clinical Research Center for Oral Diseases; and National Engineering Laboratory for Digital and Material Technology of Stomatology
| | - Guang-Yan Yu
- From the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center of Stomatology; National Clinical Research Center for Oral Diseases; and National Engineering Laboratory for Digital and Material Technology of Stomatology
| | - Xin Peng
- From the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center of Stomatology; National Clinical Research Center for Oral Diseases; and National Engineering Laboratory for Digital and Material Technology of Stomatology
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Okoturo E. Genetic determinants of periosteum-mediated craniofacial bone regeneration: a systematic review. Arch Craniofac Surg 2023; 24:251-259. [PMID: 37584066 PMCID: PMC10766501 DOI: 10.7181/acfs.2023.00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Periosteum-mediated bone regeneration (PMBR) is a recognized method for mandibular reconstruction. Despite its unpredictable nature and the limited degree to which it is understood, it does not share the concerns of developmental changes to donor and recipient tissues that other treatment options do. The definitive role of the periosteum in bone regeneration in any mammal remains largely unexplored. The purpose of this study was to identify the genetic determinants of PMBR in mammals through a systematic review. METHODS Our search methodology was designed in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. We conducted a quality assessment of each publication, and evaluated the differences in gene expression between days 7 and 15. RESULTS A total of four studies satisfied the inclusion criteria. The subjects and tissues examined in these studies were Wistar rat calvaria in two studies, mini-pigs in one study, and calves and mice in one study. Three out of the four studies achieved the necessary quality score of ≥ 3. Gene expression analysis showed increased activity of genes responsible for angiogenesis, cytokine activities, and immune-inflammatory responses on day 7. Additionally, genes related to skeletal development and signaling pathways were upregulated on day 15. Conclusions: The results suggest that skeletal morphogenesis is regulated by genes associated with skeletal development, and the gene expression patterns of PMBR may be characterized by specific pathways.
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Affiliation(s)
- Eyituoyo Okoturo
- Division of Head & Neck Cancer Oral, Department of Maxillofacial Surgery, Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria
- Molecular Oncology Program, Medical Research Centre, Lagos State University College of Medicine (LASUCOM), Lagos, Nigeria
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Liu S, Zhang WB, Yu Y, Mao C, Yu GY, Peng X. Symmetrical Midfacial Growth After Pediatric Mandibular Reconstruction With Free Fibula Flap. J Oral Maxillofac Surg 2023; 81:1594-1605. [PMID: 37741627 DOI: 10.1016/j.joms.2023.08.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Free fibula is the workhorse flap for mandibular reconstruction and is increasingly being used in pediatric patients. However, craniomaxillofacial growth and development involve interdependent processes, and it remains unknown whether mandibular reconstruction with free fibula allows symmetric growth of the midface. PURPOSE The study evaluated midfacial symmetry after pediatric mandibular defect reconstruction. STUDY DESIGN, SETTING, SAMPLE This retrospective cohort study included pediatric patients aged ≤14 years who underwent mandibular reconstruction with free fibula flap. Postoperative computed tomography data were obtained at predefined follow-up time points. Midfacial symmetry was evaluated based on 3-dimensional (3D) cephalometry. PREDICTOR VARIABLE The predictor variable was the side of the midface (affected or healthy side relative to the mandibular defect). MAIN OUTCOME VARIABLES The primary outcome variable was postoperative midfacial symmetry (at 1 week, 6 months, 1 year, 2 years, and >3 years, or after the age of 18 years), assessed in horizontal, vertical, and anteroposterior dimensions using 3D cephalometry. Another outcome variable was patient satisfaction based on a self-evaluation using visual analog scoring. COVARIATES Sex, age, diagnosis, and type of denture restoration. ANALYSES Paired t tests were performed to assess the relationship between the predictor and outcome variables, with the significance level of P < .05. RESULTS A total of 13 patients were included in this study (9 males and 4 females; mean age: 12.23 ± 2.39 years). The average distance from upper first molar point (U6) to the horizontal plane on the affected side became greater than on the healthy side (difference: 0.7 ± 0.5 mm to 1.6 ± 1.4 mm, P < .05), while the average distance from pterygomaxillary fissure to coronal plane on affected side became shorter than that on the healthy side (difference: 0.6 ± 0.6 mm to 1.2 ± 1.1 mm, P < .05) from 1 year after the surgery. There were no statistically significant differences in the remaining measurements between the 2 sides (P > .05). All the patients were satisfied with their postoperative facial symmetry. CONCLUSIONS AND RELEVANCE There were no severe midface deformities after pediatric mandibular reconstruction with free fibula flap. Meanwhile, pediatric mandibular reconstruction and proper occlusion could promote midfacial growth and symmetry.
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Affiliation(s)
- Shuo Liu
- Attending Doctor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
| | - Wen-Bo Zhang
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
| | - Yao Yu
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
| | - Chi Mao
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
| | - Guang-Yan Yu
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
| | - Xin Peng
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.
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Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Long-Term Update: Free Fibula Flap Growth After Pediatric Mandibular Reconstruction. J Craniofac Surg 2022; 34:1027-1030. [PMID: 36730843 DOI: 10.1097/scs.0000000000009091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/04/2022] [Indexed: 02/04/2023] Open
Abstract
A free fibular flap is commonly used in adult mandibular reconstruction; however, its use in the pediatric population is not strongly supported. The authors are reporting the long-term update of a case of a pediatric patient who underwent a mandibular reconstruction using a free fibular flap after a resection of mandibular desmoid fibromatosis. Greatest growth was objectively measured and demonstrated at the condyle using a 3-dimensional model generated from Materialise software. This is 1 case and subsequent studies should be observed to further elucidate the full growth potential of the mandible in pediatric patients undergoing mandibular reconstruction.
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Complex Head and Neck Resection, Reconstruction, and Rehabilitation in Children. Otolaryngol Clin North Am 2022; 55:1205-1214. [DOI: 10.1016/j.otc.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Long-term Growth, Functional, and Aesthetic Outcomes after Fibula Free Flap Reconstruction for Mandibulectomy Performed in Children. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4449. [PMID: 35923991 PMCID: PMC9333495 DOI: 10.1097/gox.0000000000004449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/19/2022] [Indexed: 11/26/2022]
Abstract
Background: The long-term outcome of mandible reconstruction when performed in children has not been well documented. Methods: This is a retrospective case series of patients who underwent immediate oncologic mandible reconstruction with a fibula free flap at younger than 18 years of age over a 20-year period, by a single surgeon, who had long-term follow-up. Results: A total of 10 patients met inclusion criteria. Patient age ranged from 3 years and 8 months to 17 years and 9 months (mean 11 years). The etiology was malignant tumors in seven patients and benign locally aggressive tumors in three patients. All fibula flaps survived. All donor sites were closed primarily. The mean follow-up duration was 10 years and 5 months (range 3–20 years). The mean patient age at follow-up was 21 years and 10 months (range 8 years and 9 months to 30 years and 9 months). All patients achieved a regular diet and normal speech. Final occlusion was normal in seven of 10 patients. The aesthetic outcome, as evaluated by clinical examination, was a symmetric mandible in eight patients (in the other two the aesthetic asymmetry and malocclusion was minor and did not require operative intervention). Dental implants were ultimately placed in three patients. Leg function was normal in eight patients. Achilles lengthening and tendon transfer was required in one patient, and one patient developed ankle pain associated with running. Conclusion: Mandible reconstruction in children with the fibula free flap provides excellent aesthetic and functional outcomes that are durable over time.
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Long-Term Facial Symmetry After Pediatric Mandibular Reconstruction Using the Vascularized Fibula Free Flap: A Photogrammetric Analysis. J Plast Reconstr Aesthet Surg 2022; 75:3956-3963. [DOI: 10.1016/j.bjps.2022.06.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 04/15/2022] [Accepted: 06/10/2022] [Indexed: 11/20/2022]
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Bansal A, Nagori SA, Chug A, Dixit A, Chowdhry R, Reddy SG. Reconstruction options in pediatric population with hemi or total mandibulectomy defects: A systematic review. J Oral Biol Craniofac Res 2022; 12:238-247. [DOI: 10.1016/j.jobcr.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 02/23/2022] [Accepted: 03/14/2022] [Indexed: 12/24/2022] Open
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Outcomes in Pediatric Maxillofacial Reconstruction With Vascularized Fibular Flaps: A Systematic Review. J Craniofac Surg 2022; 33:1346-1351. [PMID: 35184106 DOI: 10.1097/scs.0000000000008511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine the complications and outcomes after maxillofacial reconstruction using the free fibular flap in the pediatric population. METHODS A systematic review and descriptive analysis were conducted using data variables, including study characteristics; patient characteristics; postoperative complications (major and minor); surgical revision; and dental rehabilitation. RESULTS The systematic review resulted in 1622 articles, 55 of which met inclusion criteria for this study. The 55 articles consisted of 17 case series and 38 case reports with level III/IV and level V of evidence, respectively. Of the 155 identified pediatric patients, the rate of major complications was 13.5% and minor complications was 24.5%. The most common complication was mild growth distortion (n = 7) at the recipient site. Complications at the donor site were less common. During follow-up, 29 patients (18.7%) underwent or awaited surgical revision, and 43 patients (27.7%) underwent or awaited dental rehabilitation. CONCLUSIONS Our study suggests that the free fibular flap for pediatric maxillofacial reconstruction is safe and reliable. Additionally, surgical revision to correct the functional impairments resulting from primary reconstruction using the free fibular flap is relatively common.
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Resection and immediate reconstruction of two pediatric intraosseous capillary mandibular malformations. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-021-01905-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Donor-Site Morbidity Following Free Fibula Flap Harvest for Mandibular or Maxillary Reconstruction in Pediatric Patients. J Craniofac Surg 2021; 32:e464-e468. [PMID: 33405457 DOI: 10.1097/scs.0000000000007397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRO AND AIM The morbidity at the donor-site in the free fibula flap is a well-studied fact in the adult population, but in children, there are few reports of the long-term adverse effects at the donor site. In this study, we evaluate donor-site morbidity, complications, and functional outcome in pediatric patients undergoing free fibula flap harvest for mandibular or maxillary reconstruction, and the relation between pain and walking abilities. METHODS A retrospective study of 22 pediatric patients undergoing free fibula flap harvest for mandibular and maxillary reconstruction between 2003 and 2014 was conducted. A certified point evaluation system was used, analyzing several factors like pain, walking ability, restriction in activities, gait alteration, paresthesia, and cosmetic appearance, and the relationship between variables. RESULTS Mean age follow up of patient was 8.5 years (range 2-13 years). Pain was reported in 27% (n = 6), paresthesia and numbness 9% (n = 2), walking ability alteration in 50% (n = 11), restriction in activities in 18% (n = 4), gait alteration in 23% (n = 5), and cosmetic appearance alteration in the 14% (n = 3). We compare the pain and the gait alteration and did not find any relation between pain and gait alteration (P = 0.6016) and there was no relation between restriction in activities and walking ability (P = 0.1455). CONCLUSION Free fibula flap is the gold standard for head and neck reconstruction, but the morbidity at the donor site, especially in a growing child, should not be ignored or minimized when counseling patients and their families.More studies, with more population and with a long-term follow-up should be carried out to determine the impact on the daily activities on the pediatric population.
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Unique Techniques Utilizing Rib Grafts for Mandibular Reconstruction in the Pediatric Population. J Craniofac Surg 2021; 32:1780-1784. [PMID: 33852516 DOI: 10.1097/scs.0000000000007440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Pediatric mandibular reconstruction requires a grafted segment of sufficient height and stability to support dental implant placement. Double barreling and mandibular distraction osteogenesis (MDO) after reconstruction are two techniques to achieve this, but they have only been reported with fibular grafts. Rib grafts not only have a lower donor site morbidity than fibular grafts, but they also provide adequate defect coverage in children. As such, we propose their use with either a double barrel technique or with MDO. METHODS Three pediatric patients underwent mandibular resection and reconstruction using rib grafting. One patient underwent single rib graft placement with subsequent vertical rib distraction. In the remaining two patients, a double-barreled rib technique was used, stacked horizontally in one patient and vertically in the other. RESULTS From March 2018 to May 2019, three patients with an average age of 11 underwent resection of mandibular tumors or tumor-like lesions followed by immediate reconstruction with rib graft. Due to postoperative wound complications, the graft was completely removed in one patient. The remaining two patients had an uneventful recovery with dental implants planned for one and fully osseointegrated in the other. None of the patients experienced donor-site complications. CONCLUSION This case series supports the utility and versatility of autogenous rib grafts as a reconstructive option in children. Not only is rib an excellent bone source with low donor site morbidity, but its height can be augmented through MDO or double barreling, facilitating the successful placement of implants and oral rehabilitation in pediatric patients.
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Mertens F, Dormaar JT, Vander Poorten V, Vranckx JJ. Objectifying growth of vascularized bone transfers after mandibular reconstruction in the pediatric population. J Plast Reconstr Aesthet Surg 2021; 74:1973-1983. [PMID: 34187765 DOI: 10.1016/j.bjps.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Autologous vascularized bone transfer is the preferred strategy for the reconstruction of mandibular defects in a pediatric population. The principal argument is the theoretical postoperative growth potential of the neomandible, which uses vascularized donor tissues. OBJECTIVES The purpose of this study was to objectify the veritable growth potential of vascularized bone transfers in children. METHODS A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, revealing 57 patients younger than or equal to 18 years who had undergone a mandibular reconstruction with a vascularized free flap. Only studies using postoperative imaging were included. Outcomes regarding growth and postoperative corrections and complications were analyzed. RESULTS Neomandibular growth was observed in 63.2% of all included patients. The proportion of growth was higher in patients with condylar preservation (95.7%) than that of patients with condylar involvement (41.2%). Reconstruction of the condyle by a free flap, which includes an epiphyseal growth plate or cartilage increased postoperative growth potential (77.8%) but did not reduce the need for later orthognathic surgery. CONCLUSION After mandibular reconstruction with a vascularized bone transfer, the majority of pediatric patients shows neomandibular growth. Condylar preservation, the inclusion of epiphyseal growth plates or cartilage, and the patients age at the time of reconstruction are essential defining parameters.
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Affiliation(s)
- Fien Mertens
- Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Herestraat, 3000 Leuven, Belgium and OMFS-IMPATH Research Group, Kapucijnenvoer 33, 3000 Leuven, Belgium; ORL Head & Neck Surgery, University Hospital of Leuven, Herestraat, 3000 Leuven, Belgium and Department of Oncology, section Head and Neck Oncology, KU Leuven, Leuven, Belgium; Department of Plastic and Reconstructive Surgery, University Hospital of Leuven, 49 Herestraat, Herestraat 3000 Leuven, Belgium
| | - Jakob Titiaan Dormaar
- Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Herestraat, 3000 Leuven, Belgium and OMFS-IMPATH Research Group, Kapucijnenvoer 33, 3000 Leuven, Belgium.
| | - Vincent Vander Poorten
- ORL Head & Neck Surgery, University Hospital of Leuven, Herestraat, 3000 Leuven, Belgium and Department of Oncology, section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
| | - Jan Jeroen Vranckx
- Department of Plastic and Reconstructive Surgery, University Hospital of Leuven, 49 Herestraat, Herestraat 3000 Leuven, Belgium.
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Nilius M, Hölzle F, Nilius MH, Lauer G. Intraosseous venous malformation in an adolescent: Interdisciplinary concept for facial reconstruction after hemimandibulectomy, fibula free flap, and HDPE-chin reconstruction - 10 years follow up. ORAL AND MAXILLOFACIAL SURGERY CASES 2021. [DOI: 10.1016/j.omsc.2021.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pediatric Mandible Reconstruction: Controversies and Considerations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3285. [PMID: 33425597 PMCID: PMC7787291 DOI: 10.1097/gox.0000000000003285] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022]
Abstract
Mandibular reconstruction in pediatric patients has some unique considerations. The method of reconstruction has to factor in the growth potential of the neo-mandible, the native mandible, and the donor site. The condyle is considered the main growth center of the mandible. Current literature indicates that fibula, iliac crest, and scapula osseous flaps do not have the ability to grow. Costochondral grafts exhibit growth because of the costal cartilage component, although the growth is unpredictable. Preservation of the mandibular periosteum can result in spontaneous bone regeneration. Fibula bone harvest in a child mandates close follow-up till skeletal maturity, to monitor for ankle instability and valgus deformity. Dental rehabilitation maintains occlusal relationships, which promotes normal maxillary development. Elective hardware removal should be considered to facilitate future dental implant placement and possible revision procedures. After completion of growth, if occlusion or symmetry is not satisfactory, secondary procedures can be performed, including distraction osteogenesis, orthognathic-type bone sliding operations, and segmental ostectomy.
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Abramowicz S, Goudy SL, Mitchell CE, Prickett K, Marchica C, Austin TM, El-Deiry MW. A Protocol for Resection and Immediate Reconstruction of Pediatric Mandibles Using Microvascular Free Fibula Flaps. J Oral Maxillofac Surg 2020; 79:475-482. [PMID: 32950472 DOI: 10.1016/j.joms.2020.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/22/2020] [Accepted: 08/18/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The use of a vascularized free fibula graft (FFF) for the reconstruction of a mandible in a child with a mandibular tumor is infrequent. The purpose of this study is to report our protocol for resection of mandibular jaw tumors and immediate reconstruction using FFF in pediatric patients. METHODS This was a retrospective case series of children with a mandibular tumor, which was resected and immediately reconstructed with FFF. All patients were treated via the same staged protocol: 1) presurgical digital planning, 2) surgical intervention (resection and immediate reconstruction), 3) postoperative care in the pediatric intensive unit, and 4) prosthodontic dental rehabilitation. Outcomes were complications and recurrence. Medical records were reviewed to document demographic information, tumor details, surgical interventions, postoperative course, and prosthodontic rehabilitation. RESULTS Fifteen patients (10 males, average age of 13.7 years) met inclusion criteria. Ten patients had mandibular ameloblastoma. All patients were treated by a dedicated pediatric team and followed the same protocol. The average tumor size was 4.87 × 3.22 × 2.03 cm. Most fibulas (n = 12) had one osteotomy to reestablish mandibular continuity and create appropriate contour. The most common microvascular anastomosis was with a facial artery (n = 13) and the external jugular vein (n = 9). At an average follow-up of 15.5 months, there were only 3 minor donor site complications. Eight implants were placed without complications. No tumors recurred. CONCLUSIONS The results of this study suggest that pediatric mandibular tumors can be successfully treated using a specific protocol involving resection and immediate reconstruction using FFF with minimal complications and without recurrence.
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Affiliation(s)
- Shelly Abramowicz
- Associate Professor in Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Associate Chief, Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA.
| | - Steve L Goudy
- Professor and Chief, Division of Pediatric Otolaryngology, Department of Otolaryngology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Chelsea E Mitchell
- Oral and Maxillofacial Surgery Resident-In-Training, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Kara Prickett
- Associate Professor, Division of Pediatric Otolaryngology, Department of Otolaryngology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Cinzia Marchica
- Assistant Professor, Otolaryngology Head and Neck Surgery, McGill University, Montreal, Canada
| | - Thomas M Austin
- Associate Professor of Anesthesiology and Pediatrics, Department of Anesthesia, Emory University School of Medicine, Director of Operative Services, Children's Healthcare of Atlanta, Atlanta, GA
| | - Mark W El-Deiry
- Associate Professor, Head and Neck Oncology/Microvascular Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA
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Khavanin N, White MJ, Walsh JM, Steinberg JP. Mandibular Reconstruction Following Central Giant Cell Granuloma Resection in Primary Dentition: A Case for the Use of a Costochondral Graft. Cleft Palate Craniofac J 2020; 58:260-268. [PMID: 32757776 DOI: 10.1177/1055665620946985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Central giant cell granuloma is a benign, intraosseous lesion that may affect the pediatric craniofacial skeleton, particularly the mandible. When surgery is indicated, the role of the craniofacial surgeon is to ameliorate the sequelae of ablative surgery by restoring facial symmetry, ensuring appropriate postoperative occlusion, and allowing for adequate interincisal opening, all in the setting of a growing craniofacial skeleton. Herein, we report the case of a 3-year-old female presenting for reconstruction after resection of the right hemimandible proximal to the unerupted first permanent molar. We highlight the various reconstructive challenges associated with mandibular reconstruction during primary dentition and make a case for the use of a costochondral graft, with a successful outcome demonstrated at 2 years of follow-up.
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Affiliation(s)
- Nima Khavanin
- Department of Plastic and Reconstructive Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marissa J White
- Department of Pathology, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan M Walsh
- Department of Otolaryngology-Head and Neck Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jordan P Steinberg
- Department of Plastic and Reconstructive Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
INTRODUCTION The free fibula flap (FFF) is a preferred option for adult mandibular reconstruction. Due to skeletal immaturity, its routine use in pediatric patients remains in question. Inconsistencies regarding the ability of the FFF to grow in concordance with the patients' natural growth currently exist in the literature. The purpose of this report is to quantify mandibular growth in a young patient undergoing partial hemi-mandibular reconstruction with a FFF utilizing advanced three-dimensional software. METHODS A 2-year old underwent left hemi-mandibular reconstruction with a FFF following resection of a desmoid tumor. The condyle was preserved. Using 3D software, changes in mandibular growth and morphology were evaluated based on preoperative (2.1 years old) and postoperative (2.5 years and 5.2 years old) computed tomography imaging. RESULTS Mandibular growth occurred throughout the mandible in both postoperative evaluations. Greatest growth was seen in the ramus height. Fibula growth was also seen when comparing measurements to the virtual surgical planning guide. A novel parts comparison analysis revealed the greatest growth potential occurred at the condyle. CONCLUSION Providing an objective evaluation using 3D software, we have demonstrated growth throughout the reconstructed mandible, with greatest growth occurring at the preserved condyle. Despite scientific limitations of our study, the potential for mandibular growth appears to remain after FFF reconstruction, offering successful functional and cosmetic outcomes.
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Innocenti M, Mori F, Raffaini M, Lucattelli E, Innocenti A. Mandibular ramus and condyle reconstruction with vascularized proximal fibular epiphyseal transfer in the pediatric patient: A case report. Microsurgery 2020; 40:818-822. [DOI: 10.1002/micr.30589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/12/2020] [Accepted: 04/02/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Marco Innocenti
- Plastic and Reconstructive Microsurgery Careggi University Hospital Florence Italy
| | - Francesco Mori
- Plastic and Reconstructive Microsurgery Careggi University Hospital Florence Italy
| | - Mirco Raffaini
- Maxillo‐Facial Surgery Unit Careggi University Hospital Florence Italy
| | - Elena Lucattelli
- Plastic and Reconstructive Microsurgery Careggi University Hospital Florence Italy
| | - Alessandro Innocenti
- Plastic and Reconstructive Microsurgery Careggi University Hospital Florence Italy
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Pediatric Mandible Reconstruction for Osteomyelitis During Largest Reported Mycobacterium Abscessus Outbreak. J Craniofac Surg 2020; 31:274-277. [PMID: 31794447 DOI: 10.1097/scs.0000000000006070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In 2016, water lines at a children's dental clinic in Orange County, California were contaminated with Mycobacterium abscessus (MA), a non-tuberculosis rapidly-growing mycobacterium, leading to the largest MA outbreak ever reported. Mandatory reporting and active case finding directed by the Public Health Department was conducted in collaboration with community Pediatric Infectious Disease physicians for patients who underwent dental pulpotomies at the contaminated Dental Clinic from January 1 to September 6, 2016. Seventy-one cases (22 confirmed and 49 probable) were identified. One case that required extensive debridement and reconstruction of the mandible is presented in detail. CT maxillofacial demonstrated osteomyelitis extending from the right mandibular angle to the left ramus with multifocal periapical lucencies. CT chest and neck revealed numerous pulmonary nodules and bilateral cervical lymphadenopathy. Extraction of several involved teeth, bilateral selective neck dissection, and extensive mandibular debridement was performed, followed by mandibular stabilization with a custom pre-bent 2.0-mm locking plate. CT images 1-year post-operative showed clearance of infection and sufficient bony stability. Subsequent removal of hardware and bone grafting was performed and the patient is doing well. In the event of a future odontogenic mycobacterium outbreak, the experience at our institution can inform multidisciplinary treatment approaches. Prophylactic extraction of primary teeth that received pulpotomies with contaminated water should be performed. Early and thorough debridement of affected bone, including enucleation of secondary teeth, should be performed if necessary for early source control.
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Nicot R, Raoul G, Ferri J, Schlund M. Temporomandibular disorders in head and neck cancers: Overview of specific mechanisms and management. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:563-568. [PMID: 32151696 DOI: 10.1016/j.jormas.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 10/24/2022]
Abstract
Diagnosis classification system of Temporomandibular disorders (TMD) is based on the biopsychosocial model of pain. The pathogenesis is poorly understood, leading to difficulties in treating these multifactorial conditions. The predisposing factors are pathophysiological, psychological or structural processes that alter the masticatory system and lead to an increase in the risk of development of TMD. The purpose of this integrative review was then to point out the specific mechanisms of TMD in the oral oncologic context to optimize the TMJ functional results in the management of patients with oral oncologic conditions. We explored in this paper the role of Axis II assessment of the biopsychosocial model of pain, the involvement of mechanical concepts such as dental occlusion, mandibular condyle positioning and related-structures reconstruction, and the stomatognathic changes induced by radiation.
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Affiliation(s)
- R Nicot
- Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, Boulevard du Prof Emile Laine, 59000 Lille, France.
| | - G Raoul
- Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, Boulevard du Prof Emile Laine, 59000 Lille, France
| | - J Ferri
- Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, Boulevard du Prof Emile Laine, 59000 Lille, France
| | - M Schlund
- Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, Boulevard du Prof Emile Laine, 59000 Lille, France
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Considerations for Mandibular Reconstruction in the Pediatric Patient Following Resection of Malignant Tumors. J Craniofac Surg 2019; 30:e163-e168. [PMID: 30614992 DOI: 10.1097/scs.0000000000005098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We recently achieved favorable results in 3 pediatric patients with mandibular osteosarcomas that were treated at our hospital, including with immediate reconstructive surgery performed after tumor resection. Based on a literature review and practical investigation, we discuss the considerations for mandibular reconstruction after malignant lesions are removed from the mandible in children. Mandibular reconstruction for pediatric patients requires an understanding of the changes in bone and soft-tissue architecture due to growth and development at both the donor and recipient sites. Immediate mandibular reconstruction with a free flap can be considered a reasonable option even for young children who require extensive mandibular surgery. However, the variables affecting decisions about treatment planning vary between the different conditions in individual patients, and moreover, these cases are not common in the pediatric population. Therefore, long-term follow-up treatment and further investigations are required for the optimized diagnosis, treatment, and prognosis of pediatric mandibular malignancies.
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Olsson AB, Dillon J, Kolokythas A, Schlott BJ. Reconstructive Surgery. J Oral Maxillofac Surg 2019; 75:e264-e301. [PMID: 28728733 DOI: 10.1016/j.joms.2017.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Infantile myofibromatosis treated by mandibulectomy and staged reconstruction with submental flap and free fibula flap: a case report. J Otolaryngol Head Neck Surg 2019; 48:14. [PMID: 30871614 PMCID: PMC6419343 DOI: 10.1186/s40463-019-0333-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 03/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infantile myofibromatosis is the most common benign fibrous tumor in infants. Three different types have been reported in the literature. The most commonly affected areas are the head, the neck and the trunk. Our patient showed a very high level of mandibular destruction resistant to all mandibular sparing treatment strategies requiring segmental mandibulectomy and complex reconstruction. CASE PRESENTATION We describe a rare case of multicentric infantile myofibromatosis with mandibular bone destruction. The treatment required a succession of chemotherapy, a subtotal transoral resection and a hemi-mandibulectomy. The mandibular reconstruction was staged with initial bridging titanium plate with a submental flap, followed later by a fibula free flap. CONCLUSION Mandibular involvement by myofibromatosis is rare, and the extend of bone destruction and reconstruction make this case unique. To our knowledge, this is the only reported case of fibula free flap mandibular reconstruction in a patient with infantile myofibromatosis , as well as one of the youngest reported submental island flaps for any pathology. We describe the clinical presentation and management, including relevant imaging, histopathology, medical and surgical treatment as well as a review of relevant literature.
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Abstract
Maxillo-mandibular reconstruction in pediatric patients involves particular functional and cosmetic implications. Attention is required for the craniofacial growth over time, involvement of the permanent dentition, facial symmetry, and donor site morbidity. Our aim is to identify the best reconstructive options for maxilla-mandibular defects in children (<18 years) based on our experience with 25 pediatric patients. We believe that reconstruction has to be performed at the same time as resection in pediatric patients. Local flaps should be reserved for cases of maxillary defects because of malignant neoplasms, which ultimately have poor prognosis. In cases of large mandibular defects, radiotherapy is eventually required. When the condition of the soft tissues is poor (because of previous surgery, etc), free flaps potentially represent the best options. Nevertheless, in patients younger than 5 years old (with no damaged tissues), reconstruction with rib grafts should be performed, and the use of titanium plates should be reserved for very select cases (such as temporary reconstruction in toddlers).
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29
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Resnick CM, Genuth J, Calabrese CE, Taghinia A, Labow BI, Padwa BL. Temporomandibular Joint Ankylosis After Ramus Construction With Free Fibula Flaps in Children With Hemifacial Microsomia. J Oral Maxillofac Surg 2018; 76:2001.e1-2001.e15. [DOI: 10.1016/j.joms.2018.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 11/29/2022]
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Liu S, Zhang WB, Yu Y, Wang Y, Mao C, Guo CB, Yu GY, Peng X. Free Flap Transfer for Pediatric Head and Neck Reconstruction: What Factors Influence Flap Survival? Laryngoscope 2018; 129:1915-1921. [PMID: 30152141 DOI: 10.1002/lary.27442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/25/2018] [Accepted: 06/22/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Shuo Liu
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
| | - Wen-bo Zhang
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
| | - Yao Yu
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
| | - Yang Wang
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
| | - Chi Mao
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
| | - Chuan-bin Guo
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
| | - Guang-yan Yu
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
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31
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Resnick CM. Temporomandibular Joint Reconstruction in the Growing Child. Oral Maxillofac Surg Clin North Am 2018; 30:109-121. [PMID: 29153233 DOI: 10.1016/j.coms.2017.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Indications and considerations for reconstruction of the temporomandibular joint (TMJ) differ between growing and skeletally mature patients. Osteoarthritis, which is the most common cause of TMJ destruction in adults, is comparatively rare in children. The most common indications in young patients are congenital deformities, pathology, ankylosis and progressive resorptive processes. Options for reconstruction include distraction osteogenesis, autologous reconstruction (ie, costochondral graft, free fibula flap), and total alloplastic joint replacement. The choice of the ideal reconstruction is based on multiple factors, which include extent and laterality of the deformity, patient age, jaw growth pattern, and potential for progressive destruction.
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Affiliation(s)
- Cory M Resnick
- Department of Plastic and Oral Surgery, 300 Longwood Avenue, Boston, MA 02115, USA.
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Does a Vascularized Fibula Free Bone Grafted Immediately After Hemimandibulectomy in a Child Grow or Relapse During Adolescence? J Craniofac Surg 2018. [DOI: 10.1097/scs.0000000000004461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Lee JW, Bewley AF, Senders CW. Marginal versus segmental mandibulectomy for pediatric desmoid fibromatosis of the mandible - Two case reports and review of the literature. Int J Pediatr Otorhinolaryngol 2018; 109:21-26. [PMID: 29728178 DOI: 10.1016/j.ijporl.2018.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 12/11/2022]
Abstract
Desmoid fibromatosis (DF) is a rare, benign soft tissue neoplasm with high rate of local recurrence. Surgical management of DF in the head and neck can be challenging given the desire to balance the preservation of form and function with the need to minimize local recurrence by achieving complete resection. We present two contrasting cases which highlight the advantages of marginal mandibulectomy over segmental mandibulectomy in children with DF. We favor marginal mandibulectomy even with limited bone stock given the remarkable ability of children to generate new bone.
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Affiliation(s)
- Janet W Lee
- University of California Davis, Department of Otolaryngology, United States.
| | - Arnaud F Bewley
- University of California Davis, Department of Otolaryngology, United States
| | - Craig W Senders
- University of California Davis, Department of Otolaryngology, United States
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Akakpo K, Iobst C, Old M, Grischkan J. Long-term follow-up with mention of complications in pediatric microvascular mandibular reconstruction. Int J Pediatr Otorhinolaryngol 2018; 105:154-157. [PMID: 29447804 DOI: 10.1016/j.ijporl.2017.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/17/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
Abstract
The fibular free flap has become the gold standard for mandibular reconstruction. Despite its vast array of benefits, this procedure has the potential for several complications. In the pediatric setting, the immature skeleton sets the stage for an increased risk of future skeletal abnormalities, both in the jaw, and in the donor site. Herein we describe the case of a toddler who underwent mandibular reconstruction using a fibula free flap and, years later, subsequently developed ankle instability as a result of residual fibula migration. This indicates the need for careful consideration of long-term issues in the growing pediatric skeleton prior to surgery.
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Affiliation(s)
- Kenneth Akakpo
- The Ohio State University College of Medicine, Columbus, OH 43201, USA
| | - Christopher Iobst
- Department of Orthopedics, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Matthew Old
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jonathan Grischkan
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH 43205, USA; Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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35
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Skinner HR, Vargas A, Solar A, Foncea C, Astorga P. Desmoplastic Fibroma of the Mandible in a Pediatric Patient: A Case Report of Resection and Reconstruction With A Six-Year Follow-Up. J Oral Maxillofac Surg 2017; 75:1568.e1-1568.e10. [PMID: 28384463 DOI: 10.1016/j.joms.2017.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 11/29/2022]
Abstract
Desmoplastic fibroma (DF) of bone is considered a benign but locally aggressive tumor of fibroblastic origin. DF is rare, representing less than 1% of all bone tumors. Approximately 84% of patients are younger than 30 years. DF has a slow but aggressive growth potential and can recur locally when it has not been completely excised. Complete resection is the treatment of choice to decrease recurrence and morbidity. Mandibular reconstruction is mandatory in pediatric patients to ensure correct craniofacial development. The present report describes the case of a pediatric patient with mandibular DF in whom complete resection and immediate reconstruction with a fibula flap proved a satisfactory treatment option, with low morbidity and excellent esthetic and functional results at 6-year follow-up.
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Affiliation(s)
- Hernán Ramírez Skinner
- Associate Professor, Department of Surgical Oncology and Maxillofacial Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Alex Vargas
- Associate Professor, Department of Surgical Oncology and Maxillofacial Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonieta Solar
- Assistant Professor of Pathology, Bone, Oral and Head and Neck Pathology, Department of Pathology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Foncea
- Resident in Oral and Maxillofacial Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Astorga
- Observer, Department of Surgical Oncology and Maxillofacial Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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36
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Nitzan DW, Palla S. "Closed Reduction" Principles Can Manage Diverse Conditions of Temporomandibular Joint Vertical Height Loss: From Displaced Condylar Fractures to Idiopathic Condylar Resorption. J Oral Maxillofac Surg 2017; 75:1163.e1-1163.e20. [PMID: 28257719 DOI: 10.1016/j.joms.2017.01.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 01/18/2017] [Accepted: 01/22/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this case series was to describe a modification of the classic "closed reduction" technique to manage unilateral or anterior open bite owing to a loss in vertical height (LVH) caused by several disorders and pathologies other than displaced condylar fractures. MATERIALS AND METHODS The protocol included insertion of an occlusal appliance to increase the height of the premature contact and the width of the open bite, stabilization of the dental arches by rigid arches, and the use, during sleep, of rubber bands in the open bite region to pull the mandible cranially. In addition, when awake, the patient performed physiotherapy exercises to guide the mandible into maximum intercuspation. The increased open bite enhanced the effect of the rubber bands in guiding the mandible into the original habitual occlusion and the rigid arches served to minimize tooth eruption. RESULTS The present cases showed the favorable outcome of this low-risk treatment in the re-establishment of the original habitual occlusion within 1 to 4 weeks and without reconstruction of the LVH. CONCLUSION The efficacy of this complication-free approach to correct occlusion in various conditions of LVH suggests that this protocol should be applied before venturing into surgical intervention.
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Affiliation(s)
- Dorrit W Nitzan
- Professor Emeritus, Department of Oral and Maxillofacial Surgery, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
| | - Sandro Palla
- Professor Emeritus, University of Zurich, Zurich, Switzerland
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37
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Microvascular Free Tissue Transfer for Head and Neck Reconstruction in Children. J Craniofac Surg 2016; 27:846-56. [DOI: 10.1097/scs.0000000000002515] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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38
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Zhang WB, Liang T, Peng X. Mandibular growth after paediatric mandibular reconstruction with the vascularized free fibula flap: a systematic review. Int J Oral Maxillofac Surg 2016; 45:440-7. [DOI: 10.1016/j.ijom.2015.12.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 12/02/2015] [Accepted: 12/17/2015] [Indexed: 11/30/2022]
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39
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Koshy JC, Seruya M. Reconstructive algorithms in the pediatric population. J Surg Oncol 2016; 113:940-5. [DOI: 10.1002/jso.24200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/27/2016] [Indexed: 11/08/2022]
Affiliation(s)
- John C. Koshy
- Division of Plastic Surgery; Baylor College of Medicine; Houston Texas
| | - Mitchel Seruya
- Division of Plastic and Maxillofacial Surgery; USC Keck School of Medicine, Children's Hospital Los Angeles; Los Angeles California
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40
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Gougoutas AJ, Bastidas N, Bartlett SP, Jackson O. The use of computer-aided design/manufacturing (CAD/CAM) technology to aid in the reconstruction of congenitally deficient pediatric mandibles: A case series. Int J Pediatr Otorhinolaryngol 2015; 79:2332-42. [PMID: 26574173 DOI: 10.1016/j.ijporl.2015.10.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/18/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Microvascular reconstruction of the pediatric mandible, particularly when necessitated by severe, congenital hypoplasia, presents a formidable challenge. Complex cases, however, may be simplified by computer-aided design/computer-aided manufacturing (CAD/CAM) assisted surgical planning. This series represents the senior authors' preliminary experiences with CAD/CAM assisted, microvascular reconstruction of the pediatric mandible. METHODS Presented are two patients with hemifacial/bifacial microsomia, both with profound mandibular hypoplasia, who underwent CAD/CAM assisted reconstruction of their mandibles with vascularized fibula flaps. Surgical techniques, CAD/CAM routines employed, complications, and long-term outcomes are reported. RESULTS Successful mandibular reconstructions were achieved in both patients with centralization of their native mandibles and augmentation of deficient mandibular subunits. No long-term complications were observed. CONCLUSIONS CAD/CAM technology can be utilized in pediatric mandibular reconstruction, and is particularly beneficial in cases of profound, congenital hypoplasia requiring extensive, multi-planar, bony reconstructions.
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Affiliation(s)
- Alexander J Gougoutas
- University of Washington Medical Center, Center for Reconstructive Surgery, Division of Plastic Surgery, 1959 NE Pacific St., Box 356410, Seattle, WA 98195, United States.
| | - Nicholas Bastidas
- Cohen Children's Medical Center, 1991 Marcus Ave., Suite 102, North New Hyde Park, NY 11042, United States.
| | - Scott P Bartlett
- Peter Randall Endowed Chair in Pediatric Plastic Surgery, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3501 Civic Center Boulevard, 9th Floor Colket Building, Philadelphia, PA 19104, United States.
| | - Oksana Jackson
- Division of Plastic Surgery, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3501 Civic Center Boulevard, 9th Floor Colket Building, Philadelphia, PA 19104, United States.
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A case of central odontogenic fibroma in a pediatric patient: Mandibular reconstruction with parietal bone. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2014.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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42
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Smith A, Petersen D, Samant S, Ver Halen JP. Pediatric mandibular reconstruction following resection of oral squamous cell carcinoma: a case report. Am J Otolaryngol 2014; 35:826-8. [PMID: 25123780 DOI: 10.1016/j.amjoto.2014.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 07/02/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE Squamous cell carcinoma is a common entity among adult head and neck cancer patients, with many requiring reconstruction post resection. Conversely, this entity is rare among children with major reconstruction even more unique. This case and the concomitant review of literature highlight the intricacies of pediatric facial reconstruction. METHODS The case described is of a 6-year-old African-American boy with poor dentition and a painful, 1.5 cm epiphytic lesion on the alveolar ridge of the left mandible. Incisional biopsy and computerized tomography were employed to obtain diagnosis and extent of disease. Surgical resection and reconstruction followed. RESULTS Incisional biopsy confirmed the diagnosis of squamous cell carcinoma. Maxillofacial computerized tomography confirmed the extent of the mandibular lesion. After interdisciplinary discussion and weighing options with the family, a segmental mandibulectomy, neck dissection, and right fibula free flap reconstruction with titanium 2.0 mm metal plate fixation was performed. Re-examination post-operatively showed complete coverage of the defect and the ability to restore excised dentition. CONCLUSION Squamous cell carcinoma within the pediatric population occurs less often than sarcomas, but may necessitate major reconstruction. Without rigid reconstruction, contracture may result. The current consensus favors microvascular bone reconstruction. However, a lack of consensus exists regarding the timing of dental rehabilitation.
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Affiliation(s)
- Aaron Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Ave. Ste. 424, Memphis, TN, USA.
| | - Dana Petersen
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Ave. Ste. 424, Memphis, TN, USA
| | - Sandeep Samant
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Ave. Ste. 424, Memphis, TN, USA
| | - Jon P Ver Halen
- Division of Plastic Reconstructive Surgery, Baptist Cancer Center-Vanderbilt Ingram Cancer Center, 3268 Duke Circle, Germantown, TN, USA
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Temiz G, Bilkay U, Tiftikçioğlu YÖ, Mezili CT, Songür E. The evaluation of flap growth and long-term results of pediatric mandible reconstructions using free fibular flaps. Microsurgery 2014; 35:253-61. [DOI: 10.1002/micr.22334] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 09/13/2014] [Accepted: 09/17/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Gökhan Temiz
- Department of Plastic Reconstructive and Aesthetic Surgery; Dr. Lütfi Kırdar Kartal Training And Research Hospital; Kartal İstanbul Turkey
| | - Ufuk Bilkay
- Department of Plastic and Reconstructive Surgery; Ege University School of Medicine; Izmir Turkey
| | - Yiğit Özer Tiftikçioğlu
- Department of Plastic and Reconstructive Surgery; Ege University School of Medicine; Izmir Turkey
| | - Candan Tevfik Mezili
- Department of Plastic and Reconstructive Surgery; Darıca Farabi General Hospital Kocaeli; Turkey
| | - Ecmel Songür
- Department of Plastic and Reconstructive Surgery; Ege University School of Medicine; Izmir Turkey
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Bansal V, Singh S, Garg N, Dubey P. Transport distraction osteogenesis as a method of reconstruction of the temporomandibular joint following gap arthroplasty for post-traumatic ankylosis in children: a clinical and radiological prospective assessment of outcome. Int J Oral Maxillofac Surg 2014; 43:227-36. [DOI: 10.1016/j.ijom.2013.07.745] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 07/17/2013] [Accepted: 07/18/2013] [Indexed: 11/25/2022]
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45
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Brown BJ, Higgins JP, Katz RD. Histological evaluation of a free medial femoral condyle flap at 21 months. Microsurgery 2013; 33:567-71. [DOI: 10.1002/micr.22158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 06/10/2013] [Accepted: 06/18/2013] [Indexed: 11/10/2022]
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Reiser V, Alterman M, Shuster A, Kaplan I. Pediatric ameloblastic fibro-odontosarcoma of the mandible: a challenge of diagnosis and treatment. J Oral Maxillofac Surg 2012; 71:e45-57. [PMID: 23245775 DOI: 10.1016/j.joms.2012.08.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 08/26/2012] [Accepted: 08/28/2012] [Indexed: 12/24/2022]
Affiliation(s)
- Vadim Reiser
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Is Entire Removal of a Post-Traumatic Temporomandibular Joint Ankylotic Site Necessary for an Optimal Outcome? J Oral Maxillofac Surg 2012; 70:e683-99. [DOI: 10.1016/j.joms.2012.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/12/2012] [Accepted: 08/07/2012] [Indexed: 11/17/2022]
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48
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Benign paediatric mandibular tumours: Experience in reconstruction using vascularised fibula. J Plast Reconstr Aesthet Surg 2012; 65:e325-31. [DOI: 10.1016/j.bjps.2012.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 04/10/2012] [Accepted: 07/09/2012] [Indexed: 11/18/2022]
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49
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Arakeri G, Kusanale A, Zaki GA, Brennan PA. Pathogenesis of post-traumatic ankylosis of the temporomandibular joint: a critical review. Br J Oral Maxillofac Surg 2012; 50:8-12. [PMID: 20970228 DOI: 10.1016/j.bjoms.2010.09.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 09/16/2010] [Indexed: 10/18/2022]
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50
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Khadka A, Hu J. Autogenous grafts for condylar reconstruction in treatment of TMJ ankylosis: current concepts and considerations for the future. Int J Oral Maxillofac Surg 2011; 41:94-102. [PMID: 22088390 DOI: 10.1016/j.ijom.2011.10.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 07/26/2011] [Accepted: 10/20/2011] [Indexed: 11/25/2022]
Abstract
Temporomandibular joint (TMJ) ankylosis is characterized by difficulty or inability to open the mouth due to fusion of the temporal and the mandible, resulting in facial symmetry/deformity, malocclusion and dental problems. The only treatment option for TMJ ankylosis is surgical with or without condylar reconstruction. Various autogenous grafts are available for condylar reconstruction after freeing the ankylotic mass such as costochondral, sternoclavicular, fibular, coronoid, and metatarsophalangeal. Costochondral graft is preferred by surgeons, but distraction osteogenesis is slowly gaining popularity and may ultimately become the standard procedure, providing a cost-effective approach with low morbidity and excellent functional outcomes. Tissue engineering is another budding field which has shown promising results in animal studies but has not been applied to humans. To date, there is no ideal autogenous graft for condylar reconstruction that satisfies the complex anatomy and the myriad of functions of a missing condyle.
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Affiliation(s)
- A Khadka
- State Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, Sichuan University, West China College of Stomatology, Chengdu 610041, China
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