JOMS study: Protocol for bone replacement procedure successfully treats children with jaw tumors

ROSEMONT, Ill. – A protocol involving tumor removal and immediate jaw reconstruction – replacing jawbone with viable bone from the patient’s own leg – can effectively treat lower-jaw tumors with few complications in children, according to a new study.

In the study published in the February issue of the Journal of Oral and Maxillofacial Surgery, the official journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS), no tumors recurred after the procedure using microvascular free fibula grafts, which fill in jawbone with fibula leg bone. The grafts have their own blood supply through small blood vessels moved with the transplanted bone.

In addition, no complications resulted from eight dental implants, which replaced missing teeth. Three minor complications – two incision re-openings and an infection – occurred within 30 days after the procedure at the site where the fibula was removed.

The study examined 15 children at Emory University or Children’s Healthcare of Atlanta who had a tumor removed from their lower jaw before jaw reconstruction involved free fibula grafts.

The patients underwent a four-stage protocol consisting of planning, exams and evaluation before surgery, surgery, postsurgical care in an intensive care unit – including recommendations from physical therapy – and tooth replacements using dental implants. Ten patients received a removable dental appliance or procedures to prepare for implants, and two patients received dental implants.

The protocol used digital planning to prepare for tumor location, extent and removal, the graft as well as the reconstruction plate, reducing surgical time and helping determine exact insertion of the fibula for dental implant placement, researchers wrote.

The use of vascularized free fibula grafts for lower jaw reconstruction is more common in adults than children, and few surgeons have significant experience with the technique, the study notes. Using the grafts in children poses obstacles, including unknown growth and need for longer sedation, but it is suitable for lower jaw reconstruction because of length, expected blood supply and strength for dental rehabilitation, according to the study.

“Our staged protocol shortens time to return to function and improves the quality-of-life,” researchers wrote.

The authors of “A Protocol for Resection and Immediate Reconstruction of Pediatric Mandibles Using Microvascular Free Fibula Flaps” are Shelly Abramowicz, DMD, MPH; Steve L. Goudy, MD; Kara Prickett, MD; and Thomas M. Austin, MD, MS; from Emory University School of Medicine and Children’s Healthcare of Atlanta in Atlanta, Ga.; Chelsea E. Mitchell, DDS; and Mark W. El-Deiry, MD; from Emory University School of Medicine; and Cinzia Marchica, MD, from McGill University in Montreal.

The full article can be accessed at

The Journal of Oral and Maxillofacial Surgery is published by the American Association of Oral and Maxillofacial Surgeons to present to the dental and medical communities comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery. Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral and head and neck cancer, jaw reconstruction, anesthesia and analgesia. The journal also includes specifics on new instruments and diagnostic equipment, and modern therapeutic drugs and devices.