ABSTRACT
In this study, the authors review their experience with vascularized fibula transfers
for mandibular reconstruction in children. They outline the indications for such reconstruction,
their method of contouring the fibula to accurately resemble the resected mandible,
reconstruction of the temporomandibular joint, and the use of vascularized muscle
for the management of associated soft-tissue deficiencies.
Ten consecutive patients, 5 to 17 years of age and undergoing this procedure, were
assessed from a medical, dental, radiographic, and photographic standpoint. The fibulae
were elevated via a lateral approach, osteotomized, as required, and fixation was
achieved with titanium miniplates and screws. All transfers survived, with viability
confirmed by early postoperative bone scanning. Five patients had temporomandibular
joint reconstruction, and five patients required simultaneous reconstruction of soft-tissue
defects with associated vascularized muscle.
The postoperative follow-up ranged from 3 to 30 months. The occlusion of the remaining
dentition, mandibular symmetry and projection, adequacy of lining and skin cover,
and maximal mouth opening were reassessed. Occlusion was class I in all patients,
and free-flap stability and function were in the normal range. However, soft-tissue
contour was a problem. All wounds healed primarily without donor-site complications
and with minimal recipient-site complications.
