Reconstruction of the pediatric maxilla and mandible

Background: The creation of osseous defects in the upper and low er jaws in children is an uncommon occurrence. It is therefore likely that a head and neck reconstructive surgeon mill accumulate only limited experience in res toring such defects. We have reviewed 7 pediatric bone-containing microvasc ular free flap reconstruction in 6 patients for reconstruction of the upper or lower jaws. Three patients were available for long-term follow-up to ev aluate the effect of osseous free flap reconstruction on function and growt h and development of the donor site. Design: Retrospective review. Setting: Academic tertiary referral center for otolaryngology. Patients and Methods: Six pediatric patients ranging in age from 8 to 16 ye ars underwent 2 fibular, 4 scapular, and 1 iliac free flap procedure for re storation of 2 maxillary and 5 mandibular defects from 1992 to 1997. Three of the 6 patients were available for long-term follow-up to assess the post operative donor site function in an effort to determine the effect of this surgery on long-term donor site morbidity and development. Results: Two patients were lost to follow-up, and 1 died secondary to compl ications related to distant metastatic disease. Three of 6 patients were ob served for 2 years 6 months, 4 years, and 4 years 2 months, respectively.. Two of the 3 patients who were observed long term have undergone full denta l rehabilitation and currently maintain a regular diet and deny pain with m astication or deglutition. One patient did not require dental rehabilitatio n. All 3 patients demonstrate gross facial symmetry and normal dental occlu sion. Assessment of the fibular donor site demonstrated normal limb length and circumference. The patients denied pain or restriction to recreational activity. Scapular donor sites demonstrated normal range of motion, strengt h, and shoulder stability. Conclusions: Free flap reconstruction of the pediatric maxilla and mandible requires harvesting bone from actively growing donor sites. We have found no evidence of functional deficit after bone harvest from the fibular or sc apular donor sites. Patients demonstrate normal growth at the donor sites, and symmetry of the mandible and maxilla is preserved.