A Novel Algorithm for Pediatric Microsurgical Maxillomandibular Reconstruction Using Custom Endoprosthesis

PURPOSE: Treatment of pediatric jaw tumors can cause significant post-resection disfiguration and loss of function. This study evaluates reconstructive outcomes of custom endoprosthesis (CE) compared to non-custom plates(NCP) and introduces a novel algorithm using CE to optimize available vascularized free flaps. METHODS: A retrospective review of all patients undergoing maxillary or mandibular reconstruction between 2016 and 2022 was performed. Review included the following: flap type, complications, and demographics. RESULTS: Our review identified 52 patients who underwent CE/NCP implantation combined with a free fibula flap (n=13), soft-tissue free flap (n=16), iliac crest bone graft (n=5), or rib graft (n=10). Of 38 patients that underwent mandibular resection, 13 received CE and 25 NCP. In the maxillary cohort, five patients received CE and nine received NCP. The CE cohort had a lower average number of revisions than the NCP cohort (.8 vs 2.1, p=0.029) with insignificant differences in complications and donor site morbidity. CONCLUSION: Deviating from NCP, we propose a practice based algorithm for free tissue selection in jaw reconstruction. For maxillary masses, patient age determines the type of free tissue transfer accompanying the CE; while in mandibular masses, the percent of mandible resected and age informs this decision. Improved alignment and less retained hardware may contribute to reducing revisions with CE. Incorporating the CE algorithm into pediatric jaw reconstruction can facilitate improved form and function.