Bone Replacement Protocol Successfully Treats Children With Jaw Tumors

A study published in the Journal of Oral and Maxillofacial Surgery reports that a procedure consisting of removing a tumor from a patient’s jaw, followed by immediate jaw reconstruction using viable bone from the patient’s leg, can treat mandibular tumors with few complications in children. 

The authors of the study, “A Protocol for Resection and Immediate Reconstruction of Pediatric Mandibles Using Microvascular Free Fibula Flaps,” report the tumors did not recur after using microvascular free fibula grafts to fill the jawbone with fibula leg bone. Additionally, no complications occurred from replacing missing teeth with eight dental implants. Three minor complications occurred within 30 days after the procedure at the site where the fibula was removed, the team notes.

This retrospective case series examined 15 children who presented to the Oral and Maxillofacial Clinic at Emory University Children’s Healthcare of Atlanta from 2010 to 2020 who had a tumor removed from their lower jaw and immediately reconstructed using free fibula grafts. All patients were treated via a four-stage protocol consisting of planning, surgical intervention, postoperative care in the pediatric intensive unit, and prosthodontic dental rehabilitation. 

All patients underwent the same presurgical preparation consisting of a presurgical planning session that assisted with the determination of surgical margins, location of mandibular osteotomies, planning custom resection guides, and design of reconstruction plates and fibula cutting guides. All tumors were removed through neck incisions. 

Ten pediatric patients received a removable dental appliance or procedures to prepare for implants, and two patients received dental implants. The caregivers for three patients were not interested in further surgical intervention. 

Using free fibula flaps is well established in adults, however, reconstruction of the pediatric mandible has its challenges due to unpredictable skeletal growth. The study’s protocol demonstrates the importance of prosthodontic rehabilitation in children who undergo this procedure. “Our staged protocol shortens time to return to function and improves the quality of life,” the researchers note. “In children, this is particularly important since the loss of even a few days at school may significantly impact academic progress.”

Findings from the study published by the American Association of Oral and Maxillofacial Surgeons suggest pediatric mandibular tumors can be successfully treated using immediate free jaw reconstruction using free fibula flaps with “minimal complications and without reoccurrence.”