Mandibular growth after paediatric mandibular reconstruction with the vascularized free fibula flap: a systematic review

The reconstruction of mandibular defects with vascularized fibula flaps remains challenging in the paediatric population. The ability of the reconstructed mandible to grow remains controversial, and associated factors are unclear. A systematic search of the English-language and Chinese literature was conducted for the period January 1989 to April 2014 using selected key words associated with the topic. Individual patients aged <18 years who underwent mandibular reconstruction with the vascularized fibula flap and had known outcomes related to growth potential were included. Data on postoperative growth and associated factors, including condylar management, age at reconstruction, malignancy, and postoperative radiotherapy or chemotherapy, were reviewed systematically. In total, 51 patients reported in 15 articles were included. The proportion of patients with a preserved growth potential (58.8%) was higher than that of patients with no growth potential. Condylar preservation and reconstruction during the rapid growth period showed a trend towards an influence on the growth potential. Reconstruction after benign lesion resection seemed to facilitate postoperative growth, while postoperative radiotherapy inhibited growth. Reconstruction after benign lesion resection, reconstruction between 8 and 12 years of age, and condylar preservation facilitate postoperative mandibular growth, while postoperative radiotherapy inhibits the same.