| Background: Mandibular tumors,tumor-like lesions,and trauma can all cause mandibular defects,leading to facial deformities and dysfunction.When the size of jaw bone defect is too large,and pathological fractures or continuous interruptions are likely to occur,reconstruction with autologous bone allograft,allograft bone,distraction osteogenesis or microvascular free flap can be considered to restore the morphology and function of the postoperative jaw as much as possible.Although there are many methods available for repairing and reconstructing large bone defects in the mandible,it is still challenging,especially for children that are growing rapidly.The ideal reconstruction method used in children should be compatible with the growth of children’s bone tissue.The actual clinical choice should depend on the age of the patient at the time of the reconstruction and the bone mass required.Free autologous ilium transplantation is widely used in the reconstruction of maxillofacial defects.Some studies have suggested that non-vascularized bone transplantation may provide the best repair result when it is used for a defect of about 5-6 cm.But it requires sufficient soft tissue beds and periosteum preservation to optimize the biological conditions of the revascularization of the graft.Traditionally,non-vascularized free ilium grafts larger than 6 cm would not be used because they may be prone to necrosis due to difficulty in revascularization,and then lead to clinical treatment failure.In this way,the choice of the bone donor site made most families of children hesitant.The purpose of our study was to describe the feasibility of using long autologous free iliac bone grafts without the periosteum to repair and reconstruct large bone defects in mandibles in children.Methods: A case of child with mandibular ossifying fibroma,who underwent mandibular reconstruction surgery by using non-vascularized autologous iliac bone without the periosteum after the resection of the partial mandible,was analyzed retrospectively.At the same time,relevant domestic and foreign literatures were consulted to summarize the methods of repair and reconstruction of large-scale defects in the mandible and the challenges of its application in the population of children and adolescents.The feasibility of using non-vascularized non-vascularized free ilium to reconstruct children’s mandible was analyzed.It is hoped that this study could provide reference for the treatment of similar diseases in children and adolescents.Case Report: A 15-year-old male reported a chief complaint of chin bulging in the mandible that persisted for one year.Clinical and histopathological examination confirmed the diagnosis as ossifying fibroma.In consideration of the high recurrence of ossifying fibroma and malignant transformation,it was essential to expand the resection.Therefore,the surgical removal of the affected mandible was performed followed by reconstruction using the iliac bone graft without the periosteum.After surgery,follow-ups were conducted for five years to monitor the postoperative recovery of the patient.The patient did not report any complication during the follow-up period.Conclusion: Periosteum-free autologous iliac bone transplantation can be used to repair and reconstruct large mandibular bone defects in children.We recommend the use of free iliac bone grafts for repair and reconstruction of children with large mandibular defects,especially for children who are unwilling to choose vascularized free fibula flap transplantation.The non-vascularized iliac bone transplantation can provide a higher proportion of cancellous bone which is beneficial to osteogenesis.It can also be shaped in sections to improve the survival rate and adapt to the shape of the mandible.The other advantages are that the damage is relatively small and treatment time and cost are relatively little.We believe that non-periosteal and non-vascularized free iliac bone is a more appropriate surgical option for children with large mandibular defects. |
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