Mandibular ramus and condyle reconstruction with vascularized proximal fibular epiphyseal transfer in the pediatric patient: A case report

Mandibular reconstruction in skeletally immature patients is challenging for the Plastic Surgeon. Indeed, it requires replacement of the bony defect with restoration of the growth capability and joint function, when condyle is involved. Vascularized transfer of the proximal epiphysis of the fibula m...

Full description

Saved in:
Bibliographic Details
Published in:Microsurgery 2020-10, Vol.40 (7), p.818-822
Main Authors: Innocenti, Marco, Mori, Francesco, Raffaini, Mirco, Lucattelli, Elena, Innocenti, Alessandro
Format: Article
Language:English
Subjects:
Anastomosis
Biomedical materials
Blood vessels
Bone growth
Bone surgery
Case reports
Complications
Epiphysis
Fibula
Growth plate
Joints (anatomy)
Knee
Mandible
Mastication
Osteosarcoma
Patients
Pediatrics
Phonation
Temporal bone
Temporomandibular joint
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Mandibular reconstruction in skeletally immature patients is challenging for the Plastic Surgeon. Indeed, it requires replacement of the bony defect with restoration of the growth capability and joint function, when condyle is involved. Vascularized transfer of the proximal epiphysis of the fibula meets all these reconstructive requirements providing an adequate bone stock which also contains a growth plate and an articular surface. The purpose of this article is to report a case of mandibular reconstruction in a 13‐year‐old boy who underwent resection of a high‐grade osteosarcoma involving mandibular angle, ramus, and condyle. A fibular free flap including proximal epiphysis, with its growth plate and the articular surface, was harvested based on the anterior tibial vessels. The fibular head articular surface was placed facing the articular fossa of the temporal bone. A reverse‐flow end‐to‐end anastomosis was performed with the facial vessels. Postoperatively, no infection nor anastomosis complications occurred. Surgical sites healed uneventfully. At latest follow‐up, 1 year after surgery, no signs of recurrence were observed. The transferred bone survived and the growth plate was clearly open. Both functional and aesthetic outcomes were rated as good, with maximal mouth opening of more than 4 cm, neither impairment to mastication, deglutition nor phonation was observed. This technique may be a good option for pediatric reconstruction of large bony and articular mandibular defects, where functional restoration of temporomandibular joint and the growing capacity of the bone should be contemporary.
ISSN:0738-1085
1098-2752
DOI:10.1002/micr.30589