Establishing a Novel Treatment Algorithm for Pediatric Mandibular Tumor Reconstruction

Area of Science:

• Oral and Maxillofacial Surgery
• Pediatric Plastic Surgery
• Craniofacial Surgery

Background:

• Pediatric mandibular reconstruction (PMR) lacks established guidelines due to the growing craniofacial skeleton and unique patient needs.
• Traditional metrics for vascularized bone graft (VBG) use are inadequate for pediatric patients.
• Factors like dentition, speech, and secondary reconstruction impact PMR strategies.

Purpose of the Study:

• To propose a novel algorithm for pediatric mandibular reconstruction (PMR).
• To establish evidence-based guidelines for the utilization of vascularized bone grafts (VBG) in pediatric patients.
• To identify critical surgical parameters influencing PMR outcomes.

Main Methods:

• Retrospective review of 24 pediatric patients undergoing PMR for tumor resections (2005-2019).
• Analysis of patient demographics, complications, and surgical outcomes.
• Evaluation of the resection index (RI) to determine VBG utilization criteria.

Main Results:

• Vascularized bone grafts (VBG) were used in 6 patients with larger defects (12.8 cm) compared to non-VBG (6.6 cm).
• VBG group showed significantly fewer operating room returns and major complications (P=0.028).
• Non-VBG cases with a resection index (RI) > 32% had fewer complications and returns to the OR compared to those with RI < 32%.

Conclusions:

• A resection index (RI) cutoff of 32% is proposed for vascularized bone graft (VBG) use in pediatric mandibular reconstruction (PMR).
• VBG is recommended for PMR in cases with significant soft tissue defects, prior or planned adjuvant therapy, or history of failed non-VBG reconstruction.
• The proposed algorithm aims to optimize VBG selection for improved pediatric mandibular reconstruction outcomes.