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The presentation and management of mandibular tumors in the pediatric population
Margo McKenna Benoit1, Sara O Vargas, Neil Bhattacharyya
1Department of Otolaryngology, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York 14642, USA. margo_benoit@urmc.rochester.edu
Insights
Malignant tumors of the mandible in children are typically sarcomas. Surgical removal with free flap reconstruction and adjuvant therapy offers a viable treatment approach for these rare pediatric cancers.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Head and Neck Surgery
Background:
- Malignant tumors of the mandible are rare in children.
- Understanding their presentation and management is crucial for optimal outcomes.
Purpose of the Study:
- To review the clinical presentation and management strategies for malignant mandibular tumors in pediatric patients.
- To evaluate treatment modalities and outcomes in this specific population.
Main Methods:
- A case series of children (0-21 years) with malignant mandibular tumors treated at a tertiary pediatric hospital.
- Comparison with national data (Surveillance, Epidemiology, and End Results) and institutional benign lesions.
- Analysis of presentation, tumor types, surgical interventions, adjuvant therapies, and clinical outcomes.
Main Results:
- Sarcomas were the most common malignant mandibular tumors in children (71% nationally, 11/16 institutionally).
- Mandibular swelling or mass was the most frequent presentation.
- Eighty-one percent of patients underwent mandibulectomy with free tissue transfer reconstruction, and 85% received adjuvant therapy.
Conclusions:
- Malignant mandibular tumors in children are predominantly sarcomas, though other rare entities exist.
- Free flap reconstruction is a feasible and effective option for extensive mandibular surgery in pediatric patients.
- Multimodal treatment including surgery and adjuvant therapy is essential for managing these aggressive tumors.
Objectives/Hypothesis:
To review the presentation and management of malignant tumors of the mandible in children.
Study Design:
Case series.
Methods:
Children 0 to 21 years old presenting to a tertiary pediatric hospital with a diagnosis of a malignant tumor involving the mandible were included. Comparison groups included children from the Surveillance, Epidemiology, and End Results database with malignant mandible tumors as well as a group of children with benign mandibular lesions from the same institution. Main outcome measures for the institutional malignant group included presentation, tumor characteristics, treatment modalities, and clinical outcome.
Results:
Sixteen patients with malignant and 183 patients with benign lesions were identified at the primary institution. The most common presentation in both groups was mandibular swelling or mass. Malignant tumors included sarcoma (n = 11), leukemia/lymphoma (n = 2), squamous cell carcinoma (n = 1), malignant spindle cell tumor (n = 1), and yolk sac tumor (n = 1). The national database identified 56 malignant cases, of which 71% were sarcomas. Thirteen patients at our institution (81%) underwent mandibulectomy and 12 were reconstructed using free tissue transfer. Eleven of the 13 (85%) were treated with adjuvant therapy. After an average follow-up of 32.8 months, seven (44%) had no evidence of disease, three (19%) were deceased, three (19%) were alive with disease, and three (19%) were lost to follow-up.
Conclusions:
Malignant mandibular tumors in children are most often sarcomas but can include other rare lesions. Free flap reconstruction is a reasonable option for even very young children requiring extensive mandibular surgery.
