Malloy Shannon M, Dronkers Wouter J, Firriolo Joseph M, Nuzzi Laura C, Koudstaal Maarten J, Padwa Bonnie L, Taghinia Amir H, Labow Brian I
Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
Department of Oral and Maxillofacial Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Plast Reconstr Surg Glob Open. 2020 Nov 30;8(11):e3243. doi: 10.1097/GOX.0000000000003243. eCollection 2020 Nov.
The etiology and treatment of complex mandibular defects in children differ markedly from those of adults, although treatment with free bone flaps is historical in both groups. While adult outcomes and complication rates are well known, few pediatric data exist, especially for patients with congenital deficiencies. This study reports early and late outcomes from a cohort of young, primarily syndromic patients undergoing microvascular mandibular reconstruction.
This is a retrospective case series of patients who underwent microvascular mandibular reconstruction between 1995 and 2016.
Thirteen patients received a total of 13 fibula transfers and 1 medial femoral condyle transfer. Most patients carried a congenital diagnosis (77%), and the average age during surgery was 11.7 ± 5.7 years. The median (interquartile range) [IQR] length of follow-up was 6.3 (5.7) years. There was a 100% flap survival rate, although 86% of all patients experienced at least one complication. Half of all procedures resulted in an early complication. Nine patients (69%) developed late complications, of which temporal mandibular joint ankylosis was the most common (n = 5; 38%).
This study is one of few detailing outcomes following mandibular reconstruction by free flap transfer in pediatric patients. These patients were primarily syndromic with appreciable complication rates higher than in other adult and pediatric studies. Some complications are manageable or self-resolving, but others lead to functional problems that may require late operative interventions to correct. Microsurgical treatment should be reserved for children with large, complex mandibular defects when other options are unavailable or have been exhausted.
儿童复杂下颌骨缺损的病因和治疗与成人有显著差异，尽管两组都有使用游离骨瓣治疗的历史。虽然成人的治疗结果和并发症发生率已为人熟知，但儿科方面的数据很少，尤其是先天性缺陷患者的数据。本研究报告了一组接受微血管下颌骨重建的年轻患者（主要为综合征患者）的早期和晚期结果。
这是一项对1995年至2016年间接受微血管下颌骨重建患者的回顾性病例系列研究。
13例患者共接受了13次腓骨移植和1次股骨内侧髁移植。大多数患者患有先天性疾病（77%），手术时的平均年龄为11.7±5.7岁。随访的中位（四分位间距）[IQR]时长为6.3（5.7）年。皮瓣存活率为100%，尽管所有患者中有86%至少经历过一种并发症。所有手术中有一半导致了早期并发症。9例患者（69%）出现了晚期并发症，其中颞下颌关节强直最为常见（n = 5；38%）。
本研究是少数详细描述儿科患者游离皮瓣移植下颌骨重建术后结果的研究之一。这些患者主要患有综合征，并发症发生率明显高于其他成人和儿科研究。一些并发症是可控的或可自行缓解的，但其他并发症会导致功能问题，可能需要后期手术干预来纠正。当其他选择不可用或已用尽时，显微外科治疗应仅用于患有大型复杂下颌骨缺损的儿童。
