TY - JOUR
T1 - Custom Endoprosthesis
T2 - A Versatile Surgical Technique for Optimizing Pediatric Mandibular Reconstruction and Dental Restoration
AU - Kondra, Katelyn
AU - Stanton, Eloise
AU - Jimenez, Christian
AU - Garg, Ravi
AU - Liu, Alice
AU - Munabi, Naikhoba C.O.
AU - Chen, Kevin
AU - Wolfswinkel, Erik M.
AU - Steinberg, Jordan P.
AU - Urata, Mark M.
AU - Hammoudeh, Jeffrey A.
N1 - Publisher Copyright:
© The Author(s) 2022.
PY - 2023/3
Y1 - 2023/3
N2 - Goals of pediatric mandibular reconstruction are restoring form, function, and esthetics while providing platforms for dental restoration. Though many techniques recreate the inferior mandibular border, most fail to address form and function in a manner that optimizes dental rehabilitation. We describe a surgical technique using a novel custom endoprosthesis that recapitulates the native mandibular contour while supporting the bone construct in a cephalad direction with a medial ledge facilitating implant placement and oral rehabilitation. This multi-institutional retrospective review at high-volume pediatric craniofacial surgery departments features patients with large mandibular resections warranting custom constructs. Thirteen patients underwent mandibular resection and endoprosthesis reconstruction with either free fibula osteocutaneous flaps (n = 9), soft tissue free flaps without bone graft (n = 2), rib graft (n = 1), or iliac crest bone graft (n = 1). Five patients required revisions for distal flap necrosis, intraoral granuloma, and orocutaneous fistulas; one endoprosthesis required removal. Excellent esthetic and reconstructive outcomes were achieved; however, only 2 patients completed dental restoration given financial constraints. A custom endoprosthesis represents an untapped avenue toward comprehensive pediatric mandibular reconstruction. It shows compatibility with microvascular flaps while optimizing facial contour and bone height for implant placement. Given these advantages, substantial financial barriers to dental restoration should be addressed.
AB - Goals of pediatric mandibular reconstruction are restoring form, function, and esthetics while providing platforms for dental restoration. Though many techniques recreate the inferior mandibular border, most fail to address form and function in a manner that optimizes dental rehabilitation. We describe a surgical technique using a novel custom endoprosthesis that recapitulates the native mandibular contour while supporting the bone construct in a cephalad direction with a medial ledge facilitating implant placement and oral rehabilitation. This multi-institutional retrospective review at high-volume pediatric craniofacial surgery departments features patients with large mandibular resections warranting custom constructs. Thirteen patients underwent mandibular resection and endoprosthesis reconstruction with either free fibula osteocutaneous flaps (n = 9), soft tissue free flaps without bone graft (n = 2), rib graft (n = 1), or iliac crest bone graft (n = 1). Five patients required revisions for distal flap necrosis, intraoral granuloma, and orocutaneous fistulas; one endoprosthesis required removal. Excellent esthetic and reconstructive outcomes were achieved; however, only 2 patients completed dental restoration given financial constraints. A custom endoprosthesis represents an untapped avenue toward comprehensive pediatric mandibular reconstruction. It shows compatibility with microvascular flaps while optimizing facial contour and bone height for implant placement. Given these advantages, substantial financial barriers to dental restoration should be addressed.
KW - custom endoprosthesis
KW - dental restoration
KW - hemimandibulectomy
KW - pediatric mandibular reconstruction
KW - vascularized bone graft
UR - http://www.scopus.com/inward/record.url?scp=85164550371&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85164550371&partnerID=8YFLogxK
U2 - 10.1177/27325016221135376
DO - 10.1177/27325016221135376
M3 - Article
AN - SCOPUS:85164550371
SN - 2732-5016
VL - 4
SP - 72
EP - 79
JO - Face
JF - Face
IS - 1
ER -