A Novel Algorithm for Pediatric Microsurgical Maxillomandibular Reconstruction Using Custom Endoprosthesis

Collean Trotter, BA, MAT; Devon O’Brien, BS; Dylan Choi, BS; Sarah Alfeerawi, BS, MS; Idean Roohani, BS; Pasha Shakoori, MD, DDS, MA; Ja-Shen Lo, BS; Kevin Chen, MD; Mark M. Urata, MD, DDS;Jessica A. Lee, MD; Jeffrey A. Hammoudeh, MD, DDS

Background

● With a critical role in mastication, speech, and facial contour, reconstruction following resection of maxillary and mandibular tumors pose distinct challenges for microsurgeonsn

●  In pediatrics, jaw reconstruction is further complexed by the need to preserve growth potential, optimize functionality of the upper and lower jaw, and facilitate future dental restoration 

●  Current reconstruction options include Non-Custom Plates (NCP) and Custom Endoprosthesis (CE) in conjunction with vascularized free flaps

●  Literature lacks a predictable treatment algorithm for reconstruction of the pediatric maxilla and mandible

Objective

● This study aims to evaluate reconstructive outcomes of CE compared to NCP and introduce a novel algorithm using CE to optimize available vascularized free flaps in maxillomandibular reconstruction

Methods

●  IRB-approved retrospective review of pediatric patients undergoing maxillary or mandibular reconstruction by Plastic Surgery at a pediatric tertiary- care referral center (January 2016 - July 2022)

●  Patient demographics, comorbidities, perioperative data, complications, and revisions were recorded