Algorithm-Based Reconstruction for Pediatric Mandibular Desmoid Tumors: Two Decades From a Single Institution

Area of Science:

• Oncology
• Pediatric Surgery
• Craniofacial Reconstruction

Background:

• Pediatric mandibular desmoid tumors are rare, locally aggressive lesions.
• These tumors can cause significant defects in the developing craniofacial skeleton.
• Effective management strategies are crucial for optimal patient outcomes.

Purpose of the Study:

• To evaluate an algorithm-based reconstructive pathway for pediatric mandibular desmoid tumors.
• To analyze pathway assignments, transitions, and associated operative burden.
• To identify factors influencing reconstructive complexity and patient outcomes.

Main Methods:

• Retrospective review of biopsy-proven pediatric desmoid tumors involving the mandible (2004-2024).
• Application of an institutional algorithm-based reconstructive pathway (A-D) with a mandibular resection index (RI) and modifiers.
• Analysis of pathway assignments, transitions, and cumulative operative burden.

Main Results:

• Eight pediatric mandibular desmoid tumor cases were analyzed using the algorithm.
• Initial pathway assignments varied, with most patients starting in lower-risk pathways (A or B).
• Half of the patients (4/8) required escalation to a higher pathway during follow-up, leading to increased hospitalization and operative time.

Conclusions:

• Algorithm-based pathway assignment reflects the dynamic reconstructive needs of pediatric mandibular desmoid tumors.
• Pathway escalation is associated with a significantly higher cumulative surgical burden.
• Early identification of failure modes may enable earlier definitive reconstruction, potentially reducing overall treatment burden.