Free Fibula Flaps for Mandibular Reconstruction in Children with Congenital Anomalies: A Systematic Review
Laura C. Nuzzi, BA1; Joseph M. Firriolo, MD1; Rushil R. Dang, BDS, DMD2; Catherine T. McNamara, BS1; Steven J. Caldroney, DDS, MD2; John G. Meara, MD, DMD, MBA1; Brian I. Labow, MD1 1. Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. 2. Boston Medical Center, Boston, MA.
Background:
Pediatric mandibular defects of congenital origin result in physical and psychosocial destress due to functional and aesthetic deficits. While outcomes for free fibula flaps are well-studied in the adult and pediatric oncologic populations, outcomes data for the congenital pediatric population are lacking.
Methods:
We performed a comprehensive literature review and selected articles relevant to pediatric mandibular reconstruction using free fibula flaps for a congenital anomaly.
Results:
A total of 403 English language articles were identified in the initial query, with nine articles meeting inclusion criteria. Our analyses included 24 pediatric patients who underwent mandibular reconstruction using a single free fibular flap. The majority of subjects were diagnosed with hemifacial microsomia (62.5%). Two-thirds of patients were female, and the mean age at time of reconstruction was 9.2 ± 5.0 years. Postoperatively, patients were followed for a median of 45 months (interquartile range, 17 – 67 months). The overall flap success rate was 95.8%; one patient experienced flap failure (age 7 years, with an arteriovenous malformation). Roughly 16% of patients experienced at least one postoperative complication. There were no patient deaths. Information regarding postoperative occlusion was available for only nine patients, of which 22.2% (n=2) experienced malocclusion. There was insufficient information on eating and speaking outcomes.
Conclusion:
Mandibular reconstruction with free fibular flaps in children with congenital anomalies is safe and reliable. Long-term data concerning outcomes, mandibular growth, and occlusion are limited in the present literature. Additional research is needed to improve surgical decision-making and to better inform patients and their families.
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