Mandibular Defects and Reconstruction Post Oncological Resection in Paediatric Patients

Introduction: Tumours of the paediatric mandible are rare clinical entities, which require a multidisciplinary team management. Surgery is frequently utilized as a modality for local control in the management of paediatric mandibular neoplasms. However, mandibular reconstruction in such age group is more challenging than in their adult counterparts, owing to the developing nature of the mandible and the craniofacial skeleton. Materials & Methods: The medical records of patients below the age of 18 years of age presented to the Paediatric Oncology and Head and Neck Surgical Oncology Departments at the National Cancer Institute of Cairo University from January 2014 to January 2024 with mandibular tumour were reviewed. The review includes; radiological site of the lesion, histo-pathological diagnosis, multidisciplinary team management. Patients that underwent segmental mandibular resection were evaluated for the type of the resultant mandibular defects according to Brown’s classification of mandibular defects and the subsequent reconstruction procedures. Results: Forty-two patients were reported with mandibular neoplasm. Primary mandibular tumours were found in 35 cases (83.3%), of which non odontogenic tumours were diagnosed in 29 cases (69.0%). The anatomical subunits of the mandible; ramus, angle and body were involved in 14 (33.3%), 13 (31.0%) and 15 (35.7%) cases, respectively. Twenty-nine patients underwent segmental mandibular resection. According to Brown’s classification; Class I, Class Ic, Class II, Class IIc, Class III, Class IV and Class IVc were the resultant defects in 0 (0%), 2 (6.9%), 10 (35.5%), 10 (35.5%), 3 (10.3%), 0 (0%), and 4 (13.8%) cases, respectively. Conclusion: The different pathologies of the mandibular neoplasms affecting the paediatric age group frequently involve the ramus of the mandible. With the surgery being the modality of choice in most of such pathologies, the resultant defects following segmental resection and the reconstruction approach in such age group vary greatly from the adult age group. Hence, the free fibular bone segments used for restoration of the ramus projection would be of a relatively larger length. Condylar resection, unfortunately, would hinder the restoration of occlusion relationship, essential for normal development of the maxillofacial skeleton.