Background The vascularized fibula free flap is a workhorse flap in pediatric mandibular reconstruction. This study aimed to address functional outcomes, complications, and morbidity associated with the fibula resection in a consecutive series of mandibular reconstruction using this technique in skeletally immature patients. Methods Functional outcomes in terms of maximal mouth opening capacity, patient-reported eating ability, occlusion, and gait were retrospectively reviewed in 34 consecutive pediatric patients (18 males, 16 females) who underwent mandibular reconstruction using the vascularized free fibula flap. Data regarding donor and recipient site complications were also retrieved. Results The mean follow-up period was 50.6 months (range, 12–108 months). The average age was 10.3 years (range, 2–15 years). Underlying pathologies included ossifying fibroma, ameloblastoma, mandibular arteriovenous malformation, fibrous dysplasia, Goldenhar syndrome, dentigerous cyst, mandibular lymphoma, odontogenic fibroma, adenomatoid odontogenic tumor, aneurysmal bone cyst, neurogenic sarcoma, and central giant cell granuloma. Defect length ranged from 8 to 17 cm. Mean return to normal ambulation was achieved 12 days postoperatively. All patients reported ability to eat solids and liquids, with 29 of 34 achieving normal mouth opening. Normal or minimally disturbed occlusion was maintained postoperatively in most patients. Temporomandibular joint ankylosis and condylar displacement were each developed in one patient. Two patients reported gait disturbances that receded after physical therapy. No other major donor site complications, including flexion contracture of the great toe, were identified. Conclusions The vascularized fibula free flap is reaffirmed to be the criterion standard for mandible reconstruction in pediatric patients, providing satisfactory functional results and adequate adaptation to the growing facial skeleton with minimal sequelae. Complications regarding hallux function may be prevented by assessing the vascularity of the flexor hallucis longus intraoperatively and ensuring tension-free closure of the donor site.

Multisystem inflammatory syndrome in children (MIS-C) is a recently recognized spectrum of disease symptoms and signs associated with COVID-19 infection. As defined by the Centers for Disease Control and Prevention (CDC), MIS-C is diagnosed in individuals aged <21 years presenting with fever; laboratory evidence of inflammation; clinically severe illness requiring hospitalization; multisystem (≥2) organ involvement (dermatologic, cardiac, renal, respiratory, hematologic, gastrointestinal, or neurological); a positive test for current or recent SARS-CoV-2 infection, and no plausible alternative diagnoses.(Centers for Disease Control and Prevention (CDC), 2019) Among the clinical

ostparalytic facial synkinesis is a sequela after recovery of facial paralysis, resulting in involuntary and unwanted facial muscle movements during facial animation. There are various clinical presentations, such as synkinesis between mouth and eye, synkinesis between mouth and neck, and many others. [1][2][3][4] With advanced microneurovascular surgery, nerve transfer and functioning free muscle transplantation has become the primary operation for the reconstruction of longstanding facial paralysis. [5][6][7][8][9][10][11][12][13] However, the treatment of postparalytic facial synkinesis remains challenging and controversial. The mechanism of postparalytic facial synkinesis is extensively studied, but not well understood. [1][2][3][4] Recommended surgical treatments for postparalytic facial synkinesis in the literature include trunk neurectomy, 14 selective neurectomy, 15,16 highly selective neurectomy, 17 modified midface selective neurectomy, 18 selective myotomy or myectomy, 19,20 and extensive neurectomy and myectomy in the cheek and neck regions followed by functioning free muscle transplantation. 21 Each method has its advantages and disadvantages. The aim of this article is to give a comprehensive review of type II and III postparalytic facial synkinesis patients who underwent extensive reconstructive surgery at a single institution.

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