Customized Mandibular Reconstruction in an 8-Year-Old with Juvenile Ossifying Fibroma: A Case Report Using a Growth-Adaptable Titanium Implant
Abdul Hameed Attar1, Ehtaih Sham2, Satyajit Wadje3 and Rui Coelho4
1Maxillofacial Surgery Head of Department, Department of Faciomaxillary and Dental Surgery, Wockhardt hospital Mira Road Mumbai, India
2Professor Unit Head, Department of Faciomaxillary & Reconstructive Surgery, Vydehi institute of Medical & Dental Sciences, Bangalore
3Director at Braces & Faces Superspeciality Dental Care 3rd floor, 301, Commercial Complex, ROSE ICON, Pimple Saudagar, Pune, Pimpri-Chinchwad, Maharashtra 411027
4Clinical Advisor for Plastic and Maxillofacial Surgery, Director of Bone easy Research Center
*Corresponding author: Rui Coelho, Clinical Advisor for Plastic and Maxillofacial Surgery, Director of Bone easy Research Center
Citation: Attar AH, Sham E, Wadje S and Coelho R. (2024) Customized Mandibular Reconstruction in an 8-Year-Old with Juvenile Ossifying Fibroma: A Case Report Using a Growth-Adaptable Titanium Implant. Genesis J Surg Med. 3(1):1-3.
Received: September 09, 2024 | Published: September 25, 2024
Copyright© 2024 genesis pub by Attar AH, et al. CC BY-NC-ND 4.0 DEED. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 International License., This allows others distribute, remix, tweak, and build upon the work, even commercially, as long as they credit the authors for the original creation.
Abstract
Juvenile ossifying fibroma (JOF) is a rare benign fibro-osseous tumor that predominantly affects the craniofacial bones in children and adolescents. This clinical case study focuses on an 8-year-old girl from India diagnosed with JOF of the mandible, necessitating a mandibulectomy. Initial reconstruction was performed using a fibula free flap. Six weeks post-surgery, the flap showed signs of necrosis, prompting an innovative solution: the development of a patient-specific implant designed to accommodate facial growth. The implant was fabricated using advanced CT imaging, CAD design, and selective laser melting (SLM) techniques with Ti6Al4V titanium alloy, incorporating a sliding mechanism to allow for expansion as the patient matures. Follow-up over three years demonstrated successful integration of the implant, with no complications or signs of infection. The implant is planned for replacement upon reaching adulthood with a prosthesis that includes teeth connections.
Introduction
Juvenile ossifying fibroma (JOF) is a rare, benign fibro-osseous tumor characterized by the replacement of normal bone with fibrous tissue and immature bone formation. Typically affecting the craniofacial skeleton of children and young adults, JOF often presents as a painless swelling, which can lead to significant facial asymmetry. Surgical resection is the mainstay of treatment, aiming to prevent further complications and restore aesthetics and function. However, in pediatric patients, mandibular reconstruction poses unique challenges due to ongoing craniofacial growth, which must be accommodated to avoid future deformities.
In this case, an 8-year-old girl from India was diagnosed with mandibular JOF and underwent a mandibulectomy followed by reconstruction with a fibula free flap. Although fibula grafts are commonly used in adults due to their structural support and vascularization, they pose limitations in children. Grafts may not grow proportionally with the developing mandible, risking functional impairments and facial asymmetry. In this case, the initial reconstruction failed due to flap necrosis.
Considering the patient’s age and the risks of using a contralateral fibula—particularly the impact on limb growth and the potential for graft failure—the clinical team opted for an alternative solution. A patient-specific, custom titanium implant was designed to accommodate future mandibular growth. This approach prioritized preserving the patient’s developmental trajectory and functional outcomes, avoiding further risks associated with autografts 1-3,9,10-13.
Figure1: Juvenile Ossifying fibroma before removal
Case Presentation
The patient, an 8-year-old girl of Indian origin, presented with a progressive swelling of the mandible. Radiographic and histopathological examinations confirmed the diagnosis of juvenile ossifying fibroma. A mandibulectomy was performed to excise the tumor, followed by immediate reconstruction using a fibula free flap. Despite initial success, the flap showed signs of necrosis six weeks postoperatively, indicating the need for a secondary intervention. To address this complication, a custom-made implant was planned to maintain the integrity of facial tissues and accommodate growth (4,5,6,7).