Staged protocol for resection, skeletal reconstruction, and oral rehabilitation of children with jaw tumors.
OBJECTIVE
The purpose of this study was to evaluate a staged protocol for resection of jaw tumors and reconstruction including implants in pediatric patients.


METHODS
Nine children were evaluated retrospectively. Data included age at resection, tumor type, use of adjuvant therapy, type of bone graft, and number of implants. Occurrence of postoperative infection, tumor margins, recurrence, plate fractures, number of bone grafts, implants restored, and failures were recorded.


RESULTS
Ages ranged from 3.5 to 16 years with 2 maxillary and 7 mandibular tumors. Diagnoses included giant cell lesion (n = 3), osteosarcoma (n = 2), myofibroma (n = 1), ossifying fibroma (n = 1), desmoplastic fibroma (n = 1), and ameloblastoma (n = 1). No patients experienced postoperative infection, wound dehiscence, or jaw instability after en bloc resection. One patient had recurrence of a giant cell lesion. To date (mean, 56 months; range, 24 to 93 months), there have been no additional recurrences. There was 1 plate fracture. Eight patients underwent iliac bone grafts (stage 2), and in 1 patient, the mandible regenerated. There were no graft infections or wound dehiscences. Three patients required additional bone grafting for implant placement. Twenty-three implants were placed in 7 patients without complications, and 21 implants have gone to second stage. One implant failed to osseointegrate. Six patients have had prostheses placed and loaded for a mean of 26 months (range, 5 to 64 months). One patient is scheduled for prosthetic restoration and 2 for implant placement.


CONCLUSIONS
Pediatric maxillofacial tumors can be successfully treated by resection, rigid fixation, and delayed reconstruction with minimal morbidity and a high success rate.
Troulis
Maria J
MJ
Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA 02114, USA. mtroulis@partners.org
Williams
W Bradford
WB
Kaban
Leonard B
LB
D000293:Adolescent; D001860:Bone Plates; D001861:Bone Regeneration / Q000502:physiology; D016025:Bone Transplantation; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D015921:Dental Implants; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000601:surgery; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D008441:Maxillary Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D016348:Osseointegration / Q000502:physiology; D012516:Osteosarcoma / Q000601:surgery; D010158:Palatal Obturators; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome
D015921:Dental Implants