Free Flap Reconstruction for Malignant Pediatric Jaw Tumors: A Palliative Approach.

[BACKGROUND] Malignant pediatric jaw tumors are rare but challenging entities. While unresectable tumors are typically managed with chemotherapy and supportive care, our institution advocates for aggressive surgery to reduce local disease progression.

[METHODS] We retrospectively reviewed children treated for jaw tumors at a tertiary children's hospital (2006-2024). Patients with maxillary or mandibular cancers and distant metastases who underwent palliative resection followed by microsurgical reconstruction were included. Data on demographics, oncologic history, and outcomes were collected.

[RESULTS] Seven patients (mean 13.1 years) underwent resection compared to two unresected patients. Reconstruction utilized free osteocutaneous fibula (4), anterolateral thigh (2), and rectus abdominis (1). Positive resection margins occurred in 57%, with no flap losses but 43% requiring revision. Four patients expired (mean 1.3 years post-surgery). Most patients showed improvement in pain, feeding, and speech.

[CONCLUSIONS] Aggressive surgical management of metastatic pediatric jaw cancers can improve quality of life, despite incomplete resection.