Pediatric Mandible Reconstruction: Controversies and Considerations

Abstract

Summary 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.

Protocol and Evaluation of 3D-Planned Microsurgical and Dental Implant Reconstruction of Maxillary Cleft Critical Size Defects in Adolescents and Young Adults

“…For critical size defects that also include soft tissue deficiencies and/or cases that require significant reconstruction of the jawbone, 3D-VSP supported microsurgical reconstruction is indicated. During the last 20 years, craniomaxillofacial surgery has begun to undertake reconstructive treatment of post ablative and posttraumatic defects as well as congenital or acquired deformations in adults, adolescents and children [ 21 , 22 , 23 ]. Prior to dental implant treatment, cleft maxilla requires reconstruction of both hard and soft tissues.…”

Immediate Mandibular Reconstruction Using a Cellular Bone Allograft Following Tumor Resection in a Pediatric Patient

“…This is of particular concern in young children who are still growing, requiring the restoration of functionality and facial esthetics while not restricting growth. 12 Here, we report the successful immediate reconstruction of a large segmental mandibular defect using a viable cellular bone allograft, ViviGen Formable (VF-CBA), in a pediatric patient following JAOF resection. By providing all 3 essential bone remodeling properties, VF-CBA facilitated fusion at the defect site.…”

“…Pediatric mandibular reconstruction is typically accomplished using autogenous bone grafts, commonly taken from the iliac crest or fibula. 12 However, autograft harvesting in a growing child is not without potential complications. These include the typical complications associated with donor-site harvest, such as pain and infection, as well as increased operative time due to the complexity of the procedure and, potentially, increased length of hospital stay.…”

“…8 Additionally, there are potentially long-term effects related to compromised growth at the donor-sites in the skeletally-immature patient. 12,22 Application of VF-CBA eliminated the need for donor-site harvesting of autograft, thereby avoiding these perioperative and potentially long-term complications. At the same time, the custom-fabricated intraoral guides and plates provided an improved efficiency in the procedure, allowing precise placement of the plates and stability to the defect for placement of the VF-CBA graft.…”

Pediatric Orbital Floor Reconstruction with Split Corticocancellous Rib Graft

“…21,22 Furthermore, with proper periosteal repair, the ribs frequently regenerate within 3-6 months, with studies reporting complete regeneration in 44% to 98% of children. 23,24 Long-term chest deformities secondary to rib harvesting have been studied in patients who underwent microtia repair. In one study of 18 pediatric patients, local rib deformities identified via X-ray or CT ranged from 20% to 63.6%, and presented most commonly as a small groove overlaying the operative site 25 ; however, scoliosis secondary to costal cartilage harvest has been considered rare.…”