Improving aesthetic outcomes in pediatric free tissue oromandibular reconstruction.

OBJECTIVE To review our substantial favorable experience with oromandibular free tissue reconstruction in pediatric patients, emphasizing technical pearls, which seem to be associated with favorable long-term aesthetic and functional outcomes. METHODS Retrospective review of a consecutive series of all free tissue transfers performed from 1997 to 2010 by the senior author (Y.D.) in patients younger than 18 years. Demographic data, techniques used, and complications were examined. RESULTS A total of 51 patients were identified, and their data were available for collection. Twenty-eight were female, and 23 were male; the mean age was 10 years (range, 4-17 years). Flaps performed included 43 fibula free flaps and 8 radial forearm free flaps with successful transplantation in each case. Twenty-six patients had temporomandibular joint reconstruction as part of their initial repair. The reasons for reconstruction were trauma (in 18 cases) and oncologic (in 33 cases). Functional and aesthetic results were improved with minimal access, maximal exposure approaches as outlined. CONCLUSIONS Pediatric free tissue oromandibular reconstruction is associated with excellent outcomes in most patients. Specific technical modifications allowing for minimal visible scarring and improved function, particularly at the level of the joint, allow for rewarding results in young patients.