Outcomes following Microvascular Mandibular Reconstruction in Pediatric Patients and Young Adults
Background:. The etiology and treatment of complex mandibular defects in children differ markedly from those of adults, although treatment with free bone flaps is historical in both groups. While adult outcomes and complication rates are well known, few pediatric data exist, especially for patients...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2020-11-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003243 |
| _version_ | 1831559329205977088 |
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| author | Shannon M. Malloy, BS Wouter J. Dronkers, BSc Joseph M. Firriolo, MD Laura C. Nuzzi, BA Maarten J. Koudstaal, MD, DMD, PhD Bonnie L. Padwa, DMD, MD Amir H. Taghinia, MD, MPH, MBA Brian I. Labow, MD, FACS, FAAP |
| author_facet | Shannon M. Malloy, BS Wouter J. Dronkers, BSc Joseph M. Firriolo, MD Laura C. Nuzzi, BA Maarten J. Koudstaal, MD, DMD, PhD Bonnie L. Padwa, DMD, MD Amir H. Taghinia, MD, MPH, MBA Brian I. Labow, MD, FACS, FAAP |
| author_sort | Shannon M. Malloy, BS |
| collection | DOAJ |
| description | Background:. The etiology and treatment of complex mandibular defects in children differ markedly from those of adults, although treatment with free bone flaps is historical in both groups. While adult outcomes and complication rates are well known, few pediatric data exist, especially for patients with congenital deficiencies. This study reports early and late outcomes from a cohort of young, primarily syndromic patients undergoing microvascular mandibular reconstruction.
Methods:. This is a retrospective case series of patients who underwent microvascular mandibular reconstruction between 1995 and 2016.
Results:. Thirteen patients received a total of 13 fibula transfers and 1 medial femoral condyle transfer. Most patients carried a congenital diagnosis (77%), and the average age during surgery was 11.7 ± 5.7 years. The median (interquartile range) [IQR] length of follow-up was 6.3 (5.7) years. There was a 100% flap survival rate, although 86% of all patients experienced at least one complication. Half of all procedures resulted in an early complication. Nine patients (69%) developed late complications, of which temporal mandibular joint ankylosis was the most common (n = 5; 38%).
Conclusions:. This study is one of few detailing outcomes following mandibular reconstruction by free flap transfer in pediatric patients. These patients were primarily syndromic with appreciable complication rates higher than in other adult and pediatric studies. Some complications are manageable or self-resolving, but others lead to functional problems that may require late operative interventions to correct. Microsurgical treatment should be reserved for children with large, complex mandibular defects when other options are unavailable or have been exhausted. |
| first_indexed | 2024-12-17T05:27:15Z |
| format | Article |
| id | doaj.art-4fccf6e529aa4030a8e5e1ff92815c2f |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-17T05:27:15Z |
| publishDate | 2020-11-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-4fccf6e529aa4030a8e5e1ff92815c2f2022-12-21T22:01:50ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742020-11-01811e324310.1097/GOX.0000000000003243202011000-00023Outcomes following Microvascular Mandibular Reconstruction in Pediatric Patients and Young AdultsShannon M. Malloy, BS0Wouter J. Dronkers, BSc1Joseph M. Firriolo, MD2Laura C. Nuzzi, BA3Maarten J. Koudstaal, MD, DMD, PhD4Bonnie L. Padwa, DMD, MD5Amir H. Taghinia, MD, MPH, MBA6Brian I. Labow, MD, FACS, FAAP7From the * Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass.From the * Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass.From the * Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass.From the * Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass.† Department of Oral and Maxillofacial Surgery, Erasmus Medical Center, Rotterdam, The NetherlandsFrom the * Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass.From the * Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass.From the * Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass.Background:. The etiology and treatment of complex mandibular defects in children differ markedly from those of adults, although treatment with free bone flaps is historical in both groups. While adult outcomes and complication rates are well known, few pediatric data exist, especially for patients with congenital deficiencies. This study reports early and late outcomes from a cohort of young, primarily syndromic patients undergoing microvascular mandibular reconstruction. Methods:. This is a retrospective case series of patients who underwent microvascular mandibular reconstruction between 1995 and 2016. Results:. Thirteen patients received a total of 13 fibula transfers and 1 medial femoral condyle transfer. Most patients carried a congenital diagnosis (77%), and the average age during surgery was 11.7 ± 5.7 years. The median (interquartile range) [IQR] length of follow-up was 6.3 (5.7) years. There was a 100% flap survival rate, although 86% of all patients experienced at least one complication. Half of all procedures resulted in an early complication. Nine patients (69%) developed late complications, of which temporal mandibular joint ankylosis was the most common (n = 5; 38%). Conclusions:. This study is one of few detailing outcomes following mandibular reconstruction by free flap transfer in pediatric patients. These patients were primarily syndromic with appreciable complication rates higher than in other adult and pediatric studies. Some complications are manageable or self-resolving, but others lead to functional problems that may require late operative interventions to correct. Microsurgical treatment should be reserved for children with large, complex mandibular defects when other options are unavailable or have been exhausted.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003243 |
| spellingShingle | Shannon M. Malloy, BS Wouter J. Dronkers, BSc Joseph M. Firriolo, MD Laura C. Nuzzi, BA Maarten J. Koudstaal, MD, DMD, PhD Bonnie L. Padwa, DMD, MD Amir H. Taghinia, MD, MPH, MBA Brian I. Labow, MD, FACS, FAAP Outcomes following Microvascular Mandibular Reconstruction in Pediatric Patients and Young Adults Plastic and Reconstructive Surgery, Global Open |
| title | Outcomes following Microvascular Mandibular Reconstruction in Pediatric Patients and Young Adults |
| title_full | Outcomes following Microvascular Mandibular Reconstruction in Pediatric Patients and Young Adults |
| title_fullStr | Outcomes following Microvascular Mandibular Reconstruction in Pediatric Patients and Young Adults |
| title_full_unstemmed | Outcomes following Microvascular Mandibular Reconstruction in Pediatric Patients and Young Adults |
| title_short | Outcomes following Microvascular Mandibular Reconstruction in Pediatric Patients and Young Adults |
| title_sort | outcomes following microvascular mandibular reconstruction in pediatric patients and young adults |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003243 |
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