Pediatric Mandible Reconstruction: Controversies and Considerations

Area of Science:

• Oral and Maxillofacial Surgery
• Pediatric Plastic Surgery
• Regenerative Medicine

Background:

• Mandibular reconstruction in children presents unique challenges due to ongoing facial growth.
• The native mandible's growth potential, neo-mandible development, and donor site characteristics are critical considerations.

Purpose of the Study:

• To review the unique considerations for pediatric mandibular reconstruction.
• To discuss various reconstruction methods and their impact on growth and development.

Main Methods:

• Review of current literature on pediatric mandibular reconstruction techniques.
• Analysis of growth potential in different osseous flaps (fibula, iliac crest, scapula) and costochondral grafts.
• Evaluation of the role of mandibular periosteum preservation and dental rehabilitation.

Main Results:

• Osseous flaps like fibula, iliac crest, and scapula lack inherent growth potential.
• Costochondral grafts offer growth but with unpredictability.
• Preserving mandibular periosteum can promote spontaneous bone regeneration.
• Fibula harvest requires monitoring for ankle complications until skeletal maturity.
• Dental rehabilitation is crucial for maxillary development and occlusion.

Conclusions:

• Pediatric mandibular reconstruction necessitates a growth-aware approach.
• Graft selection must consider growth potential and donor site morbidity.
• Long-term management includes monitoring for complications and planning for secondary procedures if needed.