Immediate comprehensive mandibular reconstruction with fibula free flap, implant-supported dental rehabilitation, and nerve reconstruction in children: A multicenter retrospective study.

Abstract

Background: Pediatric mandibular reconstruction with immediate dental rehabilitation remains challenging. We aimed to evaluate clinical, functional, and dental outcomes of immediate mandibular reconstruction using a vascularized fibula free flap (VFFF) with simultaneous jaw reconstruction (IJR) and dental implant placement in pediatric patients.

Methods: This retrospective cohort study included a consecutive cohort of patients <18 years who underwent segmental mandibular resection followed by immediate VFFF reconstruction and IJR at three American hospitals between January 2020 and January 2026. The predictor variable was postoperative follow-up timepoint (immediate vs. long-term). The primary outcomes were grouped into clinical, functional, and growth assessments. Descriptive and appropriate bivariate statistics were performed with statistical significance set at P ≤ 0.05.

Results: Sixteen patients with benign mandibular lesions met the inclusion criteria and were followed for 1265.94 days (range, 381 to 2161 days); 37.5% were female. The mean age at surgery was 15.25±1.65 years (range, 12-17 years). There were no cases of flap loss or bony non-union, whereas dental implant failure occurred in 6.5% of the implants. All patients achieved normal oral function and no developmental abnormalities were observed at the donor site. The mean postoperative vertical mandibular growth was 1.4 cm. Significant growth was observed in condylar height (mean increase, 2.84-5.84 mm; P < 0.01) and mandibular length (mean increase, 1.43 mm; P = 0.037).

Conclusions: Despite the small sample size, immediate mandibular reconstruction using a VFFF with IJR appears to be a reliable treatment option for pediatric patients with benign mandibular tumors. However, the long-term outcomes of mandibular growth, dental implant stability, and occlusal function after skeletal growth completion require further investigation.