背景:下颌骨缺损重建可能会在儿童时期带来挑战,由于面部和下颌的生长模式。由于这些原因,在儿科患者中选择最合适的重建方案,受下颌骨恶性肿瘤影响,仍然是辩论的对象。
目的:我们研究的目的是将我们的重建时间表与现有文献进行比较,以便为当前的全景图做出个人贡献。
方法:我们执行,2019年10月,我们对2013年1月至2016年12月在我院接受活检证实的下颌骨恶性肿瘤治疗的儿科患者进行了回顾性评估.他们都接受了符合标准指南和人口统计的多模式治疗,临床,治疗,收集和分析结果参数。
结果:我们观察到手术时间较短,更快的气管造口管和饲管移除,与接受显微外科下颌骨重建的患者相比,接受移植物转移的患者住院时间较少。经过36个月的随访,骨软骨移植物显示出类似于下颌骨骨physis的生长模式(正骨图的线性和垂直比范围为0.96-1.03和1-1.02,分别)。没有记录骨巩固延迟和功能障碍。
结论:游离皮瓣在儿童下颌骨重建中需要更好的评估,腓骨近端骨phy游离皮瓣的适应症可能值得进一步研究。骨软骨移植物发现外侧缺损的指征,最大长度为50-55毫米,位于下颌支,没有巨大的牙齿或软组织缺损。髁受累并不代表使用肋骨移植物的绝对禁忌症。
BACKGROUND: Mandibular defects reconstruction could result challenging in childhood, due to facial and mandibular growth patterns. For these reasons, the choice of the most suitable reconstructive option in pediatric patients, affected by mandibular malignancies, still objects of debate.
OBJECTIVE: The aim of our study was to compare our reconstructive schedules to the existing literature in order to give a personal contribute to the present panorama.
METHODS: We performed, in October 2019, a retrospective evaluation of pediatric patients treated for biopsy-proven mandibular malignancies at our Institute between January 2013 and December 2016. All of them received multimodal therapy in accordance with standard guidelines and their demographic, clinical, treatment, and outcome parameters were collected and analyzed.
RESULTS: We observed a shorter duration of surgery, a faster tracheostomy tube and feeding-tube removal, and a minor hospitalization in patients who received grafts transfer compared to those who underwent microsurgical mandibular reconstruction. After a 36-month period of follow-up, osteochondral grafts showed a pattern of growth similar to the mandibular epiphysis (condilylion-gonion linear and vertical ratio ranging to 0.96-1.03 and 1-1.02 at orthopantomogram, respectively). No bone consolidation delays and functional impairment were recorded.
CONCLUSIONS: Free flaps mandibular reconstruction in children needs to be better assessed and proximal fibular epiphyseal free flap indication might deserve further studies. Osteochondral grafts find indication for lateral defects, 50-55 mm in maximum length and located in the mandibular ramus, without massive teeth or soft tissue defect. Condyle involvement does not represent an absolute contraindication to rib graft use.