Pediatric Aggressive Benign Mandibular Tumors: Clinical Features and Management.

INTRODUCTION: Aggressive benign mandibular tumors are uncommon in the pediatric population, and there is few publishing in the literature specifically dealing with them. Aggressive tumors can be defined based on known biologic behavior and/or histologic type and/or clinical characteristics. AIM OF THE STUDY: To review the clinical features and management of lower jaw pediatric aggressive benign tumor. PATIENTS AND METHODS: Medical records review of pediatric patients presented with aggressive benign mandibular tumors to the Maxillofacial and Plastic Surgery Department, University of Alexandria, Egypt between 2011 and 2019. RESULTS: Fifty-eight patients were included in this study, aged between 2 and 16 years (average = 11.8). Ameloblastoma was the commonest pathological diagnosis (n = 18) followed by central giant cell granuloma (n = 11) and juvenile ossifying fibroma (n = 10). Patients with central giant cell granuloma were treated by en-block resection (n = 4) or curettage after interferon alfa injection (n = 7). All other benign tumors were treated by en-block resection. The length of follow-up ranged from 1 to 8 years. Successful reconstruction was accomplished in 45 patients (88.2%). CONCLUSIONS: Aggressive lesion should be treated in an aggressive manner and immediate reconstruction is advocated. However, pharmacotherapy combined with enucleation is a more conservative approach for management of aggressive central giant cell tumors.

Modified bimaxillary distraction osteogenesis: a technique to correct facial asymmetry.

AIM: To study the efficacy of modified simultaneous maxillary-mandibular distraction to correct facial asymmetry in patients with compensated occlusion and a canted occlusal plane. PATIENTS AND METHODS: During the period January 1998-December 2003, 15 patients with facial asymmetry (8 male and 7 female, mean age 18 years) were treated using a modified technique of simultaneous maxillary-mandibular distraction. Their facial deformities were caused by hemicraniofacial microsomia (n=6) or ankylosis of the temporomandibular joint (TMJ) (n=9). RESULTS: The mean (range) gain in mandibular height was 16 (13-22) mm, and increase in elongation 14 (11-18) mm achieved over 11-22 days. Predicted movement on cephalometric analysis correlated closely with the actual distraction (mean accuracy 0.4mm). CONCLUSION: Simultaneous bimaxillary distraction osteogenesis is a robust technique that provides the surgeon with the ability to correct facial asymmetry in patients with hemicraniofacial microsomia and those with facial deformity after ankylosis of the TMJ. A cephalometric prediction tracing made before distraction is a reliable guide to the actual distraction needed to correct the facial deformities in these patients.