Downloaded from http://journals.lww.com/jcraniofacialsurgery by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 03/30/2021 Intraoral Use of Extraoral Implants for Oral Rehabilitation of a Pediatric Patient After Resection of Ewing Sarcoma of the Mandible and Reconstruction With Iliac Osteocutaneous Free Flap Ali Emre Aksu, MD,* Erhan Dursun, DDS, PhD,† Mert Calis, MD,‡ Bahadir Ersu, DDS, PhD,§ Tunc Safak, MD,|| and TolgaF. Tözüm, DDS, PhD¶ Abstract: Large osseous defects secondary to resection of the man- dibular segment may lead to significant facial deformity, functional disabilities, and associated psychologic problems. The therapeutic approach is more complicated in pediatric patients because it must not interfere with normal craniofacial growth process. Here, we present a clinical report to emphasize the application of extraoral short implants with magnetic abutments used for mandible of a growing patient reconstructed with free iliac flap after resection of Ewing sarcoma. A 5-year-old boy, complaining of an ulcerated mass of the anterior mandibular area and floor of the mouth, was referred to our clinic. Incisional biopsy from the lesion confirmed the diag- nosis of Ewing sarcoma. After resection, free iliac osteocutaneous flap, with a 6.5 Â 4.0-cm skin paddle and based on the deep circum- flex iliac vessels, was used to reconstruct the mandibular integrity and to cover the floor of the mouth simultaneously. Nine months af- ter the operation, the patient was referred for oral rehabilitation. Prosthodontic plan included the placement of 5 extraoral implants with magnetic abutment and fabrication of an implant-retained overdenture. Magnetic abutment was preferred not to interfere with the expected craniofacial growth. During a follow-up period, radio- graphic images showed no pathologic signs with consideration of overall bone loss and recurrence of the tumor; 12 months after the initiation of prosthetic loading, no peri-implant bone loss was ob- served. In conclusion, this reported case would be an example for the management of challenging pediatric mandibular tumor cases in terms of resection, reconstruction and dental rehabilitation. Key Words: Intraoral, extraoral, implant, magnetic abutment, Ewing sarcoma, pediatric patient, mandibula reconstruction, iliac osteocutaneous free flap (J Craniofac Surg 2014;25: 930–933) S urgical removal of an intraoral malignancy in the maxillofacial region often results in a substantial defect affecting both form and function. Large osseous defects in the head and neck region often lead to functional and aesthetic impairment of an individual. Resection of the mandibular segment without adequate reconstruc- tion may lead to significant facial deformity, functional disabilities, and associated psychologic problems. In addition, loss of mandibu- lar integrity as well as impaired sensory and motor control of the tongue may result in mandibular deviation as well as speech and swallowing difficulties. 1 Thus, especially when the lower jaw is in- volved, an immediate osseous reconstruction should be planned. 2 The introduction of microvascular free flaps has provided a chance to predictably restore bony and soft tissue in many cases of large and complex defects. The initial development of the iliac free flap, later followed by the free fibula, radial forearm, and scap- ula flaps, has led to the high success rate and significantly improved functional outcome seen in mandible reconstruction. 3–5 Innovations in the microvascular technique over the last 2 decades have made free flap reconstruction of the mandible the criterion standard for most patients with intraoral cancer. Full dental rehabilitation in a reconstructed area can be chal- lenging because most of these patients have medical comorbidities as well as tissue deficiency secondary to oncological resections and often require radiotherapy. Insufficient bone height, altered soft tissue, xerostomia, and loss of mucosal sensation can impair the success of tissue-borne prosthesis. 6 Osseointegrated dental implants can be successfully applied to support the stability of the denture. Although dental implant treatment is essential to oral rehabilitation in such patients, ideal implant treatment cannot be easily achieved. The therapeutic approach is more complicated in pediatric patients because it must not interfere with normal craniofacial growth process. The aim of this article was to present a clinical re- port of the application of extraoral short implants with magnetic abutments used for mandible of a growing patient reconstructed with free iliac flap after resection of Ewing sarcoma (ES). CLINICAL REPORT The patient, a 5-year-old boy, complaining of an ulcerated mass of the anterior mandibular area and floor of the mouth, was re- ferred to our clinic. A panoramic radiograph and computed tomo- graphic scan (Fig. 1) revealed an alteration in the architecture of From the Departments of *Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, †Periodontology, Faculty of Dentistry, Hacettepe University; ‡Plastic Surgery Clinic, Ankara Training and Research Hospital, Ministry of Health; Department of §Prosthodontics, Faculty of Dentistry, ||Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, and ¶Periodon- tology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey. Received September 19, 2013. Accepted for publication January 6, 2014. Address correspondence and reprint requests to Ali Emre Aksu, MD, Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Hacettepe University, Hacettepe Universitesi Hastaneleri, Plastik, Rekonstruktif ve Estetik Cerrahi AD, 06100 Sihhiye, Ankara, Turkey; E-mail: aemreaksu@gmail.com The authors report no conflicts of interest. Copyright © 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000709 CLINICAL STUDY 930 The Journal of Craniofacial Surgery • Volume 25, Number 3, May 2014 Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.