Aksu Ali Emre, Dursun Erhan, Calis Mert, Ersu Bahadir, Safak Tunc, Tözüm Tolga F
From the Departments of *Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, †Periodontology, Faculty of Dentistry, Hacettepe University; ‡Plastic Surgery Clinic, Ankara Training and Research Hospital, Ministry of Health; Department of §Prosthodontics, Faculty of Dentistry, ∥Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, and ¶Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
J Craniofac Surg. 2014 May;25(3):930-3. doi: 10.1097/SCS.0000000000000709.
Large osseous defects secondary to resection of the mandibular segment may lead to significant facial deformity, functional disabilities, and associated psychologic problems. The therapeutic approach is more complicated in pediatric patients because it must not interfere with normal craniofacial growth process. Here, we present a clinical report to emphasize the application of extraoral short implants with magnetic abutments used for mandible of a growing patient reconstructed with free iliac flap after resection of Ewing sarcoma. A 5-year-old boy, complaining of an ulcerated mass of the anterior mandibular area and floor of the mouth, was referred to our clinic. Incisional biopsy from the lesion confirmed the diagnosis of Ewing sarcoma. After resection, free iliac osteocutaneous flap, with a 6.5 × 4.0-cm skin paddle and based on the deep circumflex iliac vessels, was used to reconstruct the mandibular integrity and to cover the floor of the mouth simultaneously. Nine months after the operation, the patient was referred for oral rehabilitation. Prosthodontic plan included the placement of 5 extraoral implants with magnetic abutment and fabrication of an implant-retained overdenture. Magnetic abutment was preferred not to interfere with the expected craniofacial growth. During a follow-up period, radiographic images showed no pathologic signs with consideration of overall bone loss and recurrence of the tumor; 12 months after the initiation of prosthetic loading, no peri-implant bone loss was observed. In conclusion, this reported case would be an example for the management of challenging pediatric mandibular tumor cases in terms of resection, reconstruction and dental rehabilitation.
下颌骨节段切除术后继发的大型骨缺损可能导致严重的面部畸形、功能障碍及相关心理问题。儿科患者的治疗方法更为复杂，因为必须不干扰正常的颅面生长过程。在此，我们报告一例临床病例，强调在一名尤文肉瘤切除术后采用游离髂骨瓣重建下颌骨的生长发育期患者中应用带磁性基台的口外短种植体。一名5岁男孩因下颌前部区域及口底溃疡性肿物前来我院就诊。病变部位的切开活检确诊为尤文肉瘤。切除术后，采用以旋髂深血管为蒂、带有6.5×4.0厘米皮瓣的游离髂骨骨皮瓣重建下颌骨完整性并同时覆盖口底。术后9个月，患者前来接受口腔修复治疗。修复计划包括植入5枚带磁性基台的口外种植体并制作种植体支持式覆盖义齿。选择磁性基台是为了不干扰预期的颅面生长。在随访期间，影像学检查未发现与整体骨吸收及肿瘤复发相关的病理征象；义齿加载12个月后，未观察到种植体周围骨吸收。总之，就下颌骨肿瘤患儿在切除、重建及牙齿修复方面的处理而言，本报告病例可作为一个具有挑战性病例的范例。
