Resection of a giant ossifying fibroma through an intraoral approach in a 9-year-old child: immediate reconstruction and 6-year cephalometric follow-up.

An unusual opportunity was afforded to study the growth and development of the facial structures of a 9-year-old child who underwent major mandibular reconstruction. The longitudinal studies confirmed the present concepts of the factors responsible for mandibular growth as well as their repercussions on other facial structures. An intraoral subperiosteal resection of a major portion of the right hemimandible sparing the upper part of the mandibular ramus was required to eradicate a large ossifying fibroma. An iliac bone graft consisting of the outer table of cortical bone and cancellous bone was placed within the mucoperiosteal sac to repair the defect. It also was used to control the ramus remnant. The patient was followed for 6 years. The growth of the reconstructed mandible was in effect nearly symmetrical with the unaffected contralateral portion of the mandible, resulting in minimal facial asymmetry. The mucoperiosteum provided a vascular bed for the bone graft and the buccal sulcus was preserved, thus providing a retentive ridge and sulcus for a denture without the need to perform a skin or mucosal graft inlay procedure. The symmetrical growth of the mandible is attributed to the growth of the ramus by remodeling, resorption, deposition, and relocation and by the muscle-bone interface (the functional matrix).