Research Article| Volume 65, ISSUE 12, e325-e331, December 2012

Download started.


Benign paediatric mandibular tumours: Experience in reconstruction using vascularised fibula

Published:August 13, 2012DOI:


      The majority of the paediatric oral and maxillofacial tumours are benign and the mandible is involved in one-third of these cases. A review of the literature reveals only a handful of studies pertaining exclusively to benign paediatric mandibular tumours. The basis of this study was to fulfil the need to assess the suitability of major mandibular reconstructions using a vascularised fibular graft in cases of benign tumours in children. From April 1999 to April 2011 we have managed 18 cases of benign paediatric mandibular tumours. All the reconstructions were done using vascularised fibular graft. The age of these patients ranged from 8 to 16 years. The most common pathology seen in our series was Ameloblastoma, followed by Giant Cell Granuloma and vascular malformation. Other cases included fibrous dysplasia, aneurysmal bone cyst and odontogenic myxoma. Five of these were recurrent lesions. The mean length of the fibula harvested was 12 ± 2 cm. All the flaps in this series survived. Bone union occurred in all cases by 6 weeks. All the patients have maintained a satisfactory chin contour of the mandible during the follow-up period with minimal distortion occurring secondary to contralateral native mandibular growth in two cases. We conclude that, for benign paediatric mandibular tumours requiring major bone resection, the vascularised fibula is an excellent reconstructive option with the advantages of having a good bone stock, possibility for osteotomy, long pedicle length and potential for growth along with the possibility of dental rehabilitation.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Matsuzaka K.
        • Shimono M.
        • Uchiyama T.
        • Noma H.
        • Inoue T.
        Lesions related to the formation of bone, cartilage or cementum arising in the oral area: a statistical study and review of the literature.
        Bull Tokyo Dent Coll. 2002; 43: 173-180
        • Sato M.
        • Tanaka N.
        • Sato T.
        • Amagasa T.
        Oral and maxillofacial tumours in children: a review.
        Br J Oral Maxillofac Surg. 1997; 35: 92-95
        • El-Gehani R.
        • Orafi M.
        • Elarbi M.
        • Subhshraj K.
        Benign tumours of orofacial region at Benghazi, Libya: a study of 405 cases.
        J Craniomaxillofac Surg. 2009; 37: 370-375
        • Olvera-Caballero C.
        Mandibular reconstruction in children.
        Microsurgery. 2000; 20: 158-161
        • Warren S.M.
        • Borud L.J.
        • Brecht L.E.
        • Longaker M.T.
        • Siebert J.W.
        Microvascular reconstruction of the pediatric mandible.
        Plast Reconstr Surg. 2007; 119: 649-661
        • Phillips J.H.
        • Rechner B.
        • Tompson B.D.
        Mandibular growth following reconstruction using a free fibula graft in pediatric facial skeleton.
        Plast Reconstr Surg. 2005; 116: 419-424
        • Guo L.
        • Ferraro N.F.
        • Padwa B.L.
        • Kaban L.B.
        • Upton J.
        Vascularized fibular graft for pediatric mandibular reconstruction.
        Plast Reconstr Surg. 2008; 121: 2095-2105
        • Li J.
        • Chen W.
        • Huang Z.
        • Zhang D.
        Pediatric mandibular reconstruction after benign tumor ablation using a vascularized fibular flap.
        J Craniofac Surg. 2009; 20: 431-434
        • Mathes S.J.
        • Nahai F.
        Reconstructive surgery: principles, anatomy and technique. vol. 2. Churchill Livingstone, New York1997 (1353–1370)
        • de Lange J.
        • van den Akker H.P.
        • van den Berg H.
        Central giant cell granuloma of the jaw: a review of the literature with emphasis on therapy options.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Nov; 104: 603-615
        • Tanrýkulu R.
        • Erol B.
        • Haspolat K.
        Tumors of the maxillofacial region in children: retrospective analysis and long-term follow-up outcomes of 90 patients.
        Turk J Pediatr. 2004; 46: 60-66
        • Disa J.J.
        • Hidalgo D.A.
        Mandible reconstruction.
        in: Thorne C.H. Grabb and smith’s plastic surgery. 6th ed. Lippincott Williams & Wilkins, Philadelphia2007: 428-437
        • Foster R.D.
        • Anthony J.P.
        • Sharma A.
        • Pogrel M.A.
        Vascularized bone flaps versus nonvascularized bone grafts for mandibular reconstruction: an outcome analysis of primary bony union and endosseous implant success.
        Head Neck. 1999 Jan; 21: 66-71
        • Wei F.C.
        • Celik N.
        • Yang W.G.
        • Chen I.H.
        • Chang Y.M.
        • Chen H.C.
        Complications after reconstruction by plate and soft-tissue free flap in composite mandibular defects and secondary salvage reconstruction with osteocutaneous flap.
        Plast Reconstr Surg. 2003 Jul; 112: 37-42
        • Talesnik A.
        • Markowitz B.
        • Calcaterra T.
        • Ahn C.
        • Shaw W.
        Cost and outcome of osteocutaneous free-tissue transfer versus pedicled soft-tissue reconstruction for composite mandibular defects.
        Plast Reconstr Surg. 1996 May; 97: 1167-1178
        • Flemming A.F.S.
        • Brough M.D.
        • Evans N.D.
        • et al.
        Mandibular reconstruction using vascularised fibula.
        Br J Plast Surg. 1990; 43: 403-409
        • Robey A.B.
        • Spann M.L.
        • McAuliff T.M.
        • Meza J.L.
        • Hollins R.R.
        • Johnson P.J.
        Comparison of miniplates and reconstruction plates in fibular flap reconstruction of the mandible.
        Plast Reconstr Surg. 2008 Dec; 122: 1733-1738
        • Zoumalan R.A.
        • Hirsch D.L.
        • Levine J.P.
        • Saadeh P.B.
        Plating in microvascular reconstruction of the mandible: can fixation be too rigid?.
        J Craniofac Surg. 2009 Sep; 20: 1451-1454
        • Whitaker I.S.
        • Gulati V.
        • Ross G.L.
        • Menon A.
        • Ong T.K.
        Variations in the postoperative management of free tissue transfers to the head and neck in the United Kingdom.
        Br J Oral Maxillofac Surg. 2007 Jan; 45 (Epub 2006 Jan 24): 16-18
        • Crosby M.A.
        • Martin J.W.
        • Robb G.L.
        • Chang D.W.
        Pediatric mandibular reconstruction using a vascularized fibula flap.
        Head Neck. 2008 Mar; 30: 311-319