Free Fibula Flaps For Mandibular Reconstruction In Children With Congenital Anomalies: A Systematic Review
Laura C. Nuzzi, BA1, Joseph M. Firriolo, MD1, Rushil R. Dang, BDS, DMD2, Catherine T. McNamara, BS1, Steven J. Caldroney, DDS, MD2, Brian I. Labow, MD1.
1Boston Children's Hospital, Harvard Medical School, Boston, MA, USA, 2Boston Medical Center, Boston, MA, USA.
PURPOSE: Pediatric mandibular defects of congenital origin result in considerable physical and psychosocial distress due to functional and aesthetic deficits. While outcomes for free fibula flaps are well-studied in the adult and oncologic populations, outcomes data for the congenital pediatric population are lacking. Most pediatric outcomes studies in this area concern defects of oncologic origin and are limited to small retrospective reviews and case studies. This study aims to explore the surgical and functional outcomes of pediatric patients who have undergone mandibular reconstruction using free fibular flaps for congenital anomalies.
METHODS: We performed a comprehensive literature review and selected articles relevant to pediatric mandibular reconstruction using free fibula flaps for a congenital anomaly.
RESULTS: A total of 403 English language articles were identified in the initial query, with nine articles meeting inclusion criteria. Our analyses included 24 pediatric patients who underwent mandibular reconstruction using a single free fibular flap. The majority of subjects were diagnosed with hemifacial microsomia (62.5%). Two-thirds of patients were female, and the mean age at time of reconstruction was 9.2 ± 5.0 years. Postoperatively, patients were followed for a median of 45 months (interquartile range, 17 - 67 months). The overall flap success rate was 95.8%; one patient experienced flap failure (age 7 years, with an arteriovenous malformation). Roughly 16% of patients experienced at least one postoperative complication. There were no patient deaths. Information regarding postoperative occlusion was available for only nine patients, of which 22.2% (n=2) experienced malocclusion. There was insufficient information on eating and speaking outcomes.
CONCLUSIONS: Mandibular reconstruction with free fibular flaps in children with congenital anomalies is safe and reliable. Long-term data concerning functional outcomes, mandibular growth, and potential occlusion are limited in the present literature. Additional research is needed to improve surgical decision-making and to better inform patients and their families.
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