Reconstruction of a Combined Maxillectomy and Segmental Mandibulectomy Defect in a Seven-Year-Old with a Single Free Fibula Osteocutaneous Flap

Abstract

Combined upper alveolectomy and segmental mandibulectomy are complex defects. Reconstruction of these defects is usually suboptimal. We describe the case of a pediatric patient with vessel-depleted neck with recurrent vascular malformation involving the ramus and coronoid process of mandible and a previous history of maxillectomy and a reconstruction with anterolateral thigh flap. The patient underwent wide resection. The defects involving the upper alveolus and mandible were simultaneously reconstructed with a single free fibula flap.

Keywords: combined maxilla and mandible defect; fibula flap; mandibular reconstruction; maxillary reconstruction; pediatric patient.

Fig. 1

Preoperative frontal view photograph of the patient, prior to the latest surgery.

Fig. 2

Three dimensional CT scan with angiogram showing the lesion involving the ramus and coronoid region of left hemi-mandible with feeders from left external carotid artery.

Fig. 3

Postresection photograph showing segmental mandibulectomy defect, with preservation of a part of vertical ramus and condyle to which the plate has been attached. Note the upper alveolus defect, which has been reconstructed only with a soft-tissue flap.

Fig. 4

Fibula flap with the design for reconstruction. The intervening bone segment has been removed keeping the periosteum in continuity.

Fig. 5

Flap inset has been done to reconstruct the defect. The upper segment of the fibula has been fixed to the upper alveolus stump and the lower segments used to reconstruct the mandible.

Fig. 6

Endoscopic view of oral cavity showing the status 6 months postoperatively.

Fig. 7

Frontal view of the patient 24 months after surgery.