Long-Term Update: Free Fibula Flap Growth After Pediatric Mandibular Reconstruction

Yim, Nicholas H.; Montgomery, Ashley; Upadhyaya, Raghave M.; Buchanan, Edward P.

doi:10.1097/scs.0000000000009091

Cited by 3 publications

(3 citation statements)

References 47 publications

(214 reference statements)

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“…While postoperative fibula-mandibular synchronous growth is debated, studies endorsing positive growth after at least 3 years report increased height within the mandibular ramus and preserved condyle. [21][22][23] Mechanical stress and tension exerted on the FFF by native mandibular forces has been one of the proposed mechanisms for neomandibular growth postoperatively. 9,21 As such, the authors are in favor of removing mandibular plates once evidence of healing is apparent (6-12 months postoperatively) in order to apply native mandibular forces to the FFF and induce resultant growth.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Maxilla-Mandible Oncoplastic Reconstruction: A 25 Patient Case Series

Burns,

Yim,

Hashemi

et al. 2023

FACE

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Objective: We present a case series of 25 pediatric patients who underwent maxillary and mandibular oncoplastic reconstruction at a single institution. Further, we discussed the present review of the literature and underscored the unique considerations for the pediatric population. Methods: A retrospective chart review of 25 pediatric oncoplastic patients undergoing maxillary and/or mandibular reconstruction was performed from March 2015 to January 2022. Results: Thirteen patients underwent maxillary reconstruction, and 12 patients underwent mandibular reconstruction. The mean age of the maxillary cohort was 10.2 years, and the mean age of the mandibular cohort was 9.8 years. The age range of patients followed was from 6 months to 18.8 years. All patients displayed satisfactory postoperative swallowing and facial symmetry at subsequent follow-up visits. Conclusion: Maxillary and mandibular reconstruction following oncologic resection requires special attention in the pediatric population because of the difficulty to predict bony growth of the mid and lower face, and the resultant effects on dentition and symmetry. Our case series demonstrates successful pediatric maxillomandibular reconstruction utilizing microvascular free tissue transfer and 3D virtual surgical planning.

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Section: Discussionmentioning

confidence: 99%

Pediatric Maxilla-Mandible Oncoplastic Reconstruction: A 25 Patient Case Series

Burns,

Yim,

Hashemi

et al. 2023

FACE

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“…51,52 However, the senior author at our institution has documented several cases of postoperative growth in patients who did not receive physis transfer, likely due to inadvertent distraction from growth of the contralateral, normal mandible. 67,68 The vascularized fibula epiphyseal flap was first used in 1998 for proximal humeral reconstruction. 69 It is supplied by the recurrent epiphyseal branch from the anterior tibial artery and musculopereosteal perforators.…”

Section: Growthmentioning

confidence: 99%

Pediatric Microsurgery and Free-Tissue Transfer

Burns,

Skochdopole,

Alfaro Zeledon

et al. 2023

Semin Plast Surg

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Advancements in microsurgery, along with increased microsurgical experience in pediatric patients, have made free-tissue transfer a reliable modality for pediatric bone and soft tissue reconstruction today. Free-tissue transfer is most commonly used in children for the coverage of large or complex defects resulting from traumatic, oncologic, or congenital etiologies. While flap success and complication rates between pediatric and adult populations are similar, special considerations must be taken into account within the pediatric population. In this article, we will describe common indications, technical nuances, and clinical considerations for the management of the pediatric free-tissue transfer patient.

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“…Although free bular ap has become the gold standard technique for segmental mandibular reconstruction with high success rates in many institutions worldwide, the intricate anatomical and physiological characteristics of the TMJ still pose signi cant variability in reconstruction [24]. Numerous other treatment modalities for TMJ and condylar reconstruction have been used, such as costochondral grafting [5,17] and alloplastic TMJ replacements [14], so far with limited success due to chondral graft resorption and three-dimensional size mismatch, especially in the younger population, once they grow out of materials with limited or no potential of mandibular growth apart from vascularized autologous tissue transfers, e.g., free bular and medial femoral condylar aps [16,30].…”

Section: Introductionmentioning

confidence: 99%

Can We Raise a Sternochondral Joint Flap Based on Internal Thoracic Vessels for Temporomandibular Joint Reconstruction? A Preliminary Cadaveric Study

Alpat,

Aydın,

Kaya

et al. 2024

Preprint

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Purpose The free fibula flap is the gold standard for reconstructing mandibular defects caused by trauma, tumors, dysplastic diseases, osteoradionecrosis, and atrophy, but it has not yet been shown to be the ideal method for condylar reconstruction. This anatomical study proposes a surgically pragmatic approach to temporomandibular joint and condylar reconstruction via defining sternochondral joint vascularity.Methods Six fixed cadavers were dissected to assess the suitability of the 4th rib for the planned procedure. The internal thoracic vessels and branches near the sternochondral joint were carefully identified. The sternochondral joint flap was then harvested, focusing on cartilaginous rib to preserve the joint surface and vascular network. After contouring to fit the temporomandibular joint and condylar deformity, the flap was securely placed. Additional pedicle length measurements were taken.Results Perforators of the internal thoracic artery and vein constituted the dominant pedicle. The mean pedicle length was sufficient to reach recipient vessels on the neck. The compatibility between the 4th sternochondral flap and the glenoid fossa was confirmed.Conclusion A multitude of therapeutic approaches have been employed in the past to reconstruct the temporomandibular joint and condyle, albeit with restricted efficacy owing to chondral graft resorption or size mismatch in three-dimension. In contrast, this study shows that the fourth sternochondral joint flap is a promising free flap with ideal pedicle positioning, length, and vascular size match at the anastomosis. This technique is suitable for reconstructing this inherently difficult region of the temporomandibular joint, thereby offering reconstructive surgeons another method in their armamentarium.

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Long-Term Update: Free Fibula Flap Growth After Pediatric Mandibular Reconstruction

Cited by 3 publications

References 47 publications

Pediatric Maxilla-Mandible Oncoplastic Reconstruction: A 25 Patient Case Series

Pediatric Maxilla-Mandible Oncoplastic Reconstruction: A 25 Patient Case Series

Pediatric Microsurgery and Free-Tissue Transfer

Can We Raise a Sternochondral Joint Flap Based on Internal Thoracic Vessels for Temporomandibular Joint Reconstruction? A Preliminary Cadaveric Study

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