Unique Techniques Utilizing Rib Grafts for Mandibular Reconstruction in the Pediatric Population

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.

Dental management of long-term childhood cancer survivors: a systematic review

“…To solve these problems, depending on the patient's condition, the dentist may consider orthodontic and prosthodontic treatment with surgical intervention. Long-term followup of oral rehabilitation was evaluated in six case reports, including nine CCS with severe dental sequelae after cancer treatment (Liu et al 2021;Kotsiomiti et al 2013;King 2019;Michalak et al 2019;Zwetchkenbaum and Oh 2007;Chang and Lin 2021). The dental sequelae reported in the nine case reports were dental caries, root abnormalities, aplasia and underdevelopment of the maxilla and the alveolar ridge.…”

“…Survivors age at presentation varied from 6 to 20 years, age at diagnosis between 2 months and 8 years with rhabdomyosarcoma being the most common diagnosis. Treatment involved chemotherapy in all but two case reports in which only surgical excision was performed (Liu et al 2021;Kotsiomiti et al 2013). Five case reports had undergone concomitant radiotherapy (King 2019;Michalak et al 2019;Zwetchkenbaum and Oh 2007) and two case reports HSCT (Zwetchkenbaum and Oh 2007;King 2019).…”

Pediatric Craniofacial Tumor Reconstruction

“…Additional height may be provided with onlay bone grafting. 24,77 Small defects tend to spare the condylar epiphysis and the rib graft often grows with the mandible. In defects larger than 3 to 5 cm (index >32%), vascularized fibular, iliac, and scapular bone grafts may be utilized.…”