Dr. Sajid. S. QureshiAssociate Professor, Pediatric Oncology

Tata Memorial HospitalMumbai, INDIA

Outcomes of Resection, Reconstruction & Rehabilitation of

Pediatric Mandible & Maxilla Tumors.

Tumors of the mandible and maxilla are uncommon in children.

Resection and reconstruction remains a solemn technical challenge.

Optimal restoration of function & with

acceptable cosmesis.

Surgical approach: Mandible

OPG

CT scan

3-D imaging

Incision

Hemi-mandibulectomy

Segmental mandibulectomy

Extended Hemimandibulectomy

Maxillectomy

• Total maxillectomy

• Radical maxillectomy

• Infra-structure maxillectomy

• Medial maxillectomy

CT scan

Maxillectomy

Maxillectomy

Maxillectomy

Maxillectomy

Reconstruction technique

Mandible

• Free tissue transfer

• Myocutaneous flap

Maxilla

• Free tissue transfer

• Skin grafting & palatal obturator

Reconstruction technique

Free tissue transfer

– Fibula

– Scapula

Myocutaneous flap

– Pectoralis major (PMMC)

– Lattismus dorsi (LD)

Free fibula

Free fibula

Free fibula

Free fibula

Free fibula

• Fifteen patients with tumors of the

mandible (10) and maxilla (5) operated

between August 2005 and February 2010

were included in this analysis.

Age: 3-16 years (median 9 years)

Males : Female = 9:6

Primary site

Mandible 11

Maxilla 5

Surgery

Upfront 6

Post chemotherapy 10

Histological types

• Ewing sarcoma - 5

• Rhabdomyosarcoma - 2

• Osteosarcoma

• Epitheloid sarcoma

• Synovial sarcoma

• Undifferentiated

carcinoma

• Osteoblastoma

• Giant cell tumor

• Aggressive juvenile

fibromatosis

• Hemangioma

Surgery

• Hemimandibulectomy – 5• Extended hemimandibulectomy – 2• Posterior segmental mandibulectomy – 2 • Mid 3rd mandibulectomy • Total maxillectomy – 3• Radical maxillectomy• Infrastructure maxillectomy

Reconstruction

• Vascularized free fibula flap - 10 in 9 pts.

• PMMC flaps – 4

• Skin graft + palatal obturator - 2

Complication

• Flap losses – 2

• Edge necrosis - 1

Rehabilitation • Dental rehabilitation

�Osseo-integrated implants�Normal dental occlusion

�Regular diet & no pain with mastication or

deglutition. • Donor site

�No pain or restriction to recreational activity.

• Facial symmetry.

Average follow-up: 3 years(range 6 -101 month)

Relapse

Conclusion• Resection of jaw tumors remains a

technical challenge in children.• Several options for reconstructions

are available.• Free flap reconstruction, although

complex, offer good functional outcomes.

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