title: Mandibular growth following reconstruction using a free fibula graft in the pediatric facial skeleton.
abstract: BACKGROUND
  Mandible reconstruction in the growing facial skeleton is challenging, especially with reconstructions necessitating free vascularized bone grafts. The need for further combined orthodontic-orthognathic intervention at skeletal maturity must be anticipated. The growth potential of these grafts and potential new problems associated with performing a sagittal split osteotomy at skeletal maturity are poorly understood.
  
  
  METHODS
  A retrospective chart review revealed 11 patients who underwent reconstruction with a free fibula at The Hospital for Sick Children from 1990 to 2000. Radiographic and photographic studies were assessed for long-term growth of the reconstructed mandible, with follow-up ranging from 2 to 12 years.
  
  
  RESULTS
  Of the 11 patients who underwent reconstruction with a free fibula, two had surgery at skeletal maturity, two moved out of the country, one died as a result of her malignancy, and one was lost to follow-up. The remaining five patients are being followed by the craniofacial and orthodontic services and have not reached skeletal maturity. Of the two patients who have had orthognathic surgery, the one patient whose reconstruction involved the temporomandibular joint exhibited no growth on the reconstructed side and required a 57-mm advancement on the reconstructed side. The other patient, who had preservation of the temporomandibular joint at the time of reconstruction, required only a 5-mm advancement on the reconstructed side. Both patients had significant surgical complications as a result of the initial reconstructive techniques. Technical modifications necessary at the initial reconstruction became apparent when the authors performed a sagittal split osteotomy on the reconstructed side.
  
  
  CONCLUSIONS
  Certain technical modifications to the original free fibula reconstructed pediatric mandible should be considered in anticipation of the need for a subsequent bilateral sagittal split at skeletal maturity.
authors.affiliation: Hospital for Sick Children, Toronto, Ontario, Canada. joun.phillips@utoronto.ca
authors.forename: John H
authors.initials: JH
authors.lastname: Phillips
authors.forename: Benjamin
authors.initials: B
authors.lastname: Rechner
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Tompson
mesh_terms: D000293:Adolescent; D001165:Arteriovenous Malformations / Q000601:surgery; D001860:Bone Plates; D001863:Bone Screws; D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005360:Fibula / Q000637:transplantation*; D006801:Humans; D008297:Male; D008334:Mandible / Q000254:growth & development / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery*; D010027:Osteotomy; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies