16.0: Thursday, March 17, 2005

Hypoplastic mandible and chimeric free flap reconstruction

Cameron I. Earl, MD and Salvatore C. Lettieri, MD.

Patients born with hypoplastic mandible syndrome are rare which has limited experience with reconstruction. Reconstructive techniques include distraction osteogenesis, bone grafts including rib and iliac crest, and free tissue transfer. The need for free tissue transfer is uncommon owing to the success of distraction osteogenesis. This is a case presentation of utilizing a chimeric free tissue transfer for severely hypoplastic mandible.

The patient is a 17 year-old male with severely hypoplastic mandible requiring emergency tracheostomy at birth followed by gastrostomy tube placement. Raised as a mute, he learned sign language. The purpose of the reconstruction was to provide a more reasonable appearance and possibly alleviate the permanent tracheostomy.

Surgical planning included tissue expansion and subsequent free tissue transfer. He underwent a chimeric free tissue transfer which included vascularized fibula and anterolateral thigh flap. The remaining mandible was split and utilized to reconstruct the ramus. The vestige condyles remained in the hypoplastic glenoid fossa and the muscle attachments remained. Postoperatively, the patient has had immediate improvement in his self-esteem and is being weaned from the tracheostomy.

In this case report, congenital hypoplastic mandible syndromes will be reviewed, and the rare circumstances necessitating a chimeric free flap will be discussed.