Reconstruction of the pediatric maxilla and mandible.
BACKGROUND
The creation of osseous defects in the upper and lower jaws in children is an uncommon occurrence. It is therefore likely that a head and neck reconstructive surgeon will accumulate only limited experience in restoring such defects. We have reviewed 7 pediatric bone-containing microvascular free flap reconstructions in 6 patients for reconstruction of the upper or lower jaws. Three patients were available for long-term follow-up to evaluate the effect of osseous free flap reconstruction on function and growth and development of the donor site.


METHODS
Retrospective review.


METHODS
Academic tertiary referral center for otolaryngology.


METHODS
Six pediatric patients ranging in age from 8 to 16 years underwent 2 fibular, 4 scapular, and 1 iliac free flap procedure for restoration of 2 maxillary and 5 mandibular defects from 1992 to 1997. Three of the 6 patients were available for long-term follow-up to assess the postoperative donor site function in an effort to determine the effect of this surgery on long-term donor site morbidity and development.


RESULTS
Two patients were lost to follow-up, and 1 died secondary to complications related to distant metastatic disease. Three of 6 patients were observed for 2 years 6 months, 4 years, and 4 years 2 months, respectively. Two of the 3 patients who were observed long term have undergone full dental rehabilitation and currently maintain a regular diet and deny pain with mastication or deglutition. One patient did not require dental rehabilitation. All 3 patients demonstrate gross facial symmetry and normal dental occlusion. Assessment of the fibular donor site demonstrated normal limb length and circumference. The patients denied pain or restriction to recreational activity. Scapular donor sites demonstrated normal range of motion, strength, and shoulder stability.


CONCLUSIONS
Free flap reconstruction of the pediatric maxilla and mandible requires harvesting bone from actively growing donor sites. We have found no evidence of functional deficit after bone harvest from the fibular or scapular donor sites. Patients demonstrate normal growth at the donor sites, and symmetry of the mandible and maxilla is preserved.
Genden
E M
EM
Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA. eric_genden@smtplink.mssm.edu
Buchbinder
D
D
Chaplin
J M
JM
Lueg
E
E
Funk
G F
GF
Urken
M L
ML
D000293:Adolescent; D016025:Bone Transplantation; D002648:Child; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D008441:Maxillary Neoplasms / Q000601:surgery*; D009065:Mouth Rehabilitation; D012189:Retrospective Studies; D013524:Surgical Flaps