Reconstruction of the pediatric midface following oncologic resection

Evan S. Garfein, Matthew Doscher, Oren M. Tepper, Jonathan Gill, Richard Gorlick, Richard V. Smith

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Sarcoma is the most common midface malignancy in children. While first-line treatment in adults is resection, the challenges associated with resection and reconstruction of these tumors in children often lead to radiation therapy as primary treatment. This report highlights the feasibility and efficacy of midface reconstruction in the pediatric population after resection. In most cases, the same principles utilized in reconstructing midface defects in adults hold for the pediatric population. Patients and Methods From 2008 to 2013 seven pediatric patients underwent resection and reconstruction for maxillary sarcomas. These patients ranged in age from 18 months to 20 years. Five patients were reconstructed with six microvascular free flaps. Two patients received pedicled flaps. Follow-up ranged from 15 months to 4.5 years. Reconstructive, oncological, and functional outcomes were analyzed. Results Seven patients underwent eight reconstructions for sarcomas of the maxilla. Flaps utilized included vertical rectus abdominis, anterolateral thigh, fibula, and temporoparietal fascia. One flap was complicated by venous thrombosis but was successfully salvaged after thrombectomy and revision using vein graft. One patient developed recurrence after initial flap placement and required salvage resection and a second free flap. Six patients were judged to have good facial symmetry and tolerated a regular oral diet with normal or near-normal dental occlusion. Conclusions Standard primary therapy for sarcomas of the maxilla in the pediatric population consists of nonsurgical management. However, a radiation-first approach is associated with significant morbidity and makes surgical salvage more difficult. Based on our experience, microsurgical reconstruction of the pediatric midface is safe and effective, and should be considered a first-line treatment option for midface sarcomas in children. In general, there is no significant area of departure between the principles that govern midface reconstruction in adults and children.

Original languageEnglish (US)
Article number140223
Pages (from-to)336-342
Number of pages7
JournalJournal of Reconstructive Microsurgery
Volume31
Issue number5
DOIs
StatePublished - Nov 16 2014

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Pediatrics
Sarcoma
Free Tissue Flaps
Maxilla
Dental Occlusion
Population
Rectus Abdominis
Thrombectomy
Fibula
Surgical Flaps
Fascia
Therapeutics
Thigh
Venous Thrombosis
Veins
Neoplasms
Radiotherapy
Radiation
Diet
Morbidity

Keywords

  • midface
  • pediatric
  • reconstruction
  • sarcoma

ASJC Scopus subject areas

  • Surgery

Cite this

Reconstruction of the pediatric midface following oncologic resection. / Garfein, Evan S.; Doscher, Matthew; Tepper, Oren M.; Gill, Jonathan; Gorlick, Richard; Smith, Richard V.

In: Journal of Reconstructive Microsurgery, Vol. 31, No. 5, 140223, 16.11.2014, p. 336-342.

Research output: Contribution to journalArticle

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abstract = "Background Sarcoma is the most common midface malignancy in children. While first-line treatment in adults is resection, the challenges associated with resection and reconstruction of these tumors in children often lead to radiation therapy as primary treatment. This report highlights the feasibility and efficacy of midface reconstruction in the pediatric population after resection. In most cases, the same principles utilized in reconstructing midface defects in adults hold for the pediatric population. Patients and Methods From 2008 to 2013 seven pediatric patients underwent resection and reconstruction for maxillary sarcomas. These patients ranged in age from 18 months to 20 years. Five patients were reconstructed with six microvascular free flaps. Two patients received pedicled flaps. Follow-up ranged from 15 months to 4.5 years. Reconstructive, oncological, and functional outcomes were analyzed. Results Seven patients underwent eight reconstructions for sarcomas of the maxilla. Flaps utilized included vertical rectus abdominis, anterolateral thigh, fibula, and temporoparietal fascia. One flap was complicated by venous thrombosis but was successfully salvaged after thrombectomy and revision using vein graft. One patient developed recurrence after initial flap placement and required salvage resection and a second free flap. Six patients were judged to have good facial symmetry and tolerated a regular oral diet with normal or near-normal dental occlusion. Conclusions Standard primary therapy for sarcomas of the maxilla in the pediatric population consists of nonsurgical management. However, a radiation-first approach is associated with significant morbidity and makes surgical salvage more difficult. Based on our experience, microsurgical reconstruction of the pediatric midface is safe and effective, and should be considered a first-line treatment option for midface sarcomas in children. In general, there is no significant area of departure between the principles that govern midface reconstruction in adults and children.",
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