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Mandibular deformities may be secondary to congenital malformations, cancer or vascular malformations in childhood. There are several reconstructive options, the fibula free flap is the gold standard in children and adults nowadays.
Mandibular growth occurs through the epiphyseal proliferation found in the condyle and remodelation.
The fibula has endochondral growth through ossification centers, located proximally in the epiphysis, another medial, and distal.
The aim of this study is to report the long-term follow-up of patients with maxillary or mandibular reconstruction with free fibula flap in infancy.
Material and Methods.
All patients treated at the Hospital General Dr Manuel Gea Gonzalez, with fibula flap in pediatric age between 1999 and 2014, were included. In the follow-up the length of the fibula and clinical and skeletal facial symmetry were determined trough clinical photographs, panoramic x-rays and serial tomography.
Results.
Twenty patients were included, who were operated at an average age of 8.25 years old, with an average follow-up of 6 years, maximum 13, minimum of 2 years. The 70% of the patients had a diagnosis of hemifacial microsomia, 25% of cancer, 5% of facial fissure 3-11 associated with hemifacial microsomia, and 5% of mandibular arteriovenous malformation.
The total of the fibula flap were used for head and neck reconstruction. 10% for maxillary and 90% for mandibular reconstruction. In 25% of the cases the fibula length was smaller than the one that had been placed, reason why it is suspected resorption of the same one. In 75% of the cases, the fibula flap was equal to the fibula placed, however, in 95% of the patients, there was no growth evidence.
Conclusion.
The free fibula flap is the best reconstructive option for maxillary and mandibular defects in children, however the flap has no growth potential per se. That is why secondary procedures such as distraction of the flap are necessary to obtain better symmetry and functional results.