title: Reconstruction of the pediatric midface following oncologic resection.
abstract: BACKGROUND
  Sarcoma is the most common midface malignancy in children. While first-line treatment in adults is resection, the challenges associated with resection and reconstruction of these tumors in children often lead to radiation therapy as primary treatment. This report highlights the feasibility and efficacy of midface reconstruction in the pediatric population after resection. In most cases, the same principles utilized in reconstructing midface defects in adults hold for the pediatric population.
  
  
  METHODS
  From 2008 to 2013 seven pediatric patients underwent resection and reconstruction for maxillary sarcomas. These patients ranged in age from 18 months to 20 years. Five patients were reconstructed with six microvascular free flaps. Two patients received pedicled flaps. Follow-up ranged from 15 months to 4.5 years. Reconstructive, oncological, and functional outcomes were analyzed.
  
  
  RESULTS
  Seven patients underwent eight reconstructions for sarcomas of the maxilla. Flaps utilized included vertical rectus abdominis, anterolateral thigh, fibula, and temporoparietal fascia. One flap was complicated by venous thrombosis but was successfully salvaged after thrombectomy and revision using vein graft. One patient developed recurrence after initial flap placement and required salvage resection and a second free flap. Six patients were judged to have good facial symmetry and tolerated a regular oral diet with normal or near-normal dental occlusion.
  
  
  CONCLUSIONS
  Standard primary therapy for sarcomas of the maxilla in the pediatric population consists of nonsurgical management. However, a radiation-first approach is associated with significant morbidity and makes surgical salvage more difficult. Based on our experience, microsurgical reconstruction of the pediatric midface is safe and effective, and should be considered a first-line treatment option for midface sarcomas in children. In general, there is no significant area of departure between the principles that govern midface reconstruction in adults and children.
authors: Department of Otorhinolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors: Evan
authors: E
authors: Garfein
authors: Department of Surgery, Division of Plastic and Reconstructive Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors: Matthew
authors: M
authors: Doscher
authors: Department of Surgery, Division of Plastic and Reconstructive Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors: Oren
authors: O
authors: Tepper
authors: Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors: Jonathan
authors: J
authors: Gill
authors: Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors: Richard
authors: R
authors: Gorlick
authors: Department of Otorhinolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors: Richard V
authors: RV
authors: Smith
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005153:Facial Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D007223:Infant; D008297:Male; D008437:Maxilla / Q000601:surgery; D008866:Microsurgery; D020360:Neoadjuvant Therapy; D019651:Plastic Surgery Procedures / Q000379:methods*; D012208:Rhabdomyosarcoma / Q000601:surgery*; D012509:Sarcoma / Q000601:surgery*; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D055815:Young Adult