Immediate Comprehensive Mandibular Reconstruction with Fibula Free Flap, Implant-Supported Dental Rehabilitation, and Nerve Reconstruction in Children: A Multicenter Retrospective Study

Background Pediatric mandibular reconstruction with immediate dental rehabilitation remains challenging. This study aimed to evaluate the clinical, functional, and dental outcomes of immediate mandibular reconstruction using a vascularized fibula free flap (VFFF) with immediate jaw reconstruction (IJR) with dental implants in pediatric patients. Methods This retrospective cohort study included a consecutive cohort of patients younger than 18 years who underwent segmental mandibular resection followed by immediate VFFF reconstruction and IJR at three American hospitals between January 2020 and January 2026. The predictor variable was postoperative follow-up timepoint (immediate vs. long-term). The primary outcomes were grouped into clinical and functional assessment and growth assessment. Descriptive and appropriate bivariate statistics were performed, with statistical significance set at P ≤ 0.05. Results Sixteen patients with benign mandibular lesions met the inclusion criteria and were followed for 1265.94 days (range, 381 to 2161 days); 37.5% were female. The mean age at surgery was 15.25±1.65 years (range, 12-17 years). There were no cases of flap loss or bony non-union, while dental implant failure occurred in 6.5% of implants. All patients achieved normal oral function, and no developmental abnormalities were observed at the donor site. The mean postoperative vertical mandibular growth was 1.4cm. Significant growth was observed in both condylar height (mean increase, 2.84-5.84mm; P < 0.01) and mandibular length (mean increase, 1.43mm; P=0.037). Conclusions Despite the small sample size, immediate mandibular reconstruction using a VFFF with IJR appears to be a reliable treatment option for pediatric patients with benign mandibular tumors. However, the long-term outcomes of mandibular growth, dental implant stability, and occlusal function after completion of skeletal growth require further investigation.