Long-term facial symmetry after pediatric mandibular reconstruction using the vascularized fibula free flap: A photogrammetric analysis

Background: The fibula free flap is the standard of care in the reconstruction of large mandibular defects in pediatric patients, enabling adequate restoration of the facial contour. However, the unpredictable growth potential of the reconstructed mandible could influence the preservation of the initially restored symmetry over time. Being mindful of the importance of facial appearance during developmental stages, this study aimed to evaluate the long-term facial symmetry after mandible reconstruction using this technique in growing patients.Patients and Methods: A photogrammetric analysis of facial symmetry using the "Asymmetry Index" (AI) was performed from preoperative and postoperative frontal photographs in 17 pe-diatric patients (9 males and 8 females) who underwent mandibular reconstruction with the vascularized fibula free flap and had a minimum follow-up of 5 years. Comparisons between preoperative and postoperative measurements-as well as postoperative comparisons between condyle-reconstructed and condyle-preserved patients-were conducted.Results: The mean follow-up was 76.9 (+/- 19.0) months (range, 60-120). The average age at intervention was 9.23 (+/- 3.8) years. Mean AI was 15.31 (+/- 1.81) preoperatively and 3.59 (+/- 0.97) postoperatively. Differences between preoperative and postoperative measurementswere statistically significant in all the assessed parameters ( p < 0.001). Postoperative differ-ences between the condyle-reconstructed and the condyle-preserved groups were not signifi-cant ( p > 0.05). No secondary procedures were required to enhance symmetry in the late post-operative period.Conclusions: Mandibular reconstruction using the vascularized fibula free flap provides ad-equate restoration of facial symmetry that could be predictably maintained throughout the developmental period in children and adolescents, regardless of the need for condylar recon-struction.(c) 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by El-sevier Ltd. All rights reserved.