This is a retrospective chart review of outcomes of maxillofacial microvascular free flap reconstructions in pediatric and adolescent patients. A single head and neck surgical team performed all the included 136 procedures. Demographic and surgical patient data were recorded. Type of transfer performed in each recipient site and major complications were analyzed. Relevant influencing factors, such as age, gender and etiology of defect were determined using the ANOVA test and χ² test of independence. Results indicate a 90% success rate. No significant relation was found between the incidence of total flap loss and patient age, etiology or graft source. The maxillary reconstructions showed a higher incidence of total flap loss compared to mandibular ones (11 vs. 3 cases). Despite the high success rate, the findings underline the necessity for further research to validate these observations and enhance surgical methods for pediatric and adolescent patients.

Background: Glossopharyngeal neuralgia is a rare cranial neuropathy characterized by paroxysmal, severe pain localized to the sensory distribution of the glossopharyngeal nerve. Diagnostic overlap with trigeminal neuralgia can lead to misclassification and delays in effective management. Case Report: We report a 76-year-old female with an 18-year history of right-sided tongue and facial pain initially misdiagnosed as trigeminal neuralgia. Despite undergoing radiotherapy, thermolesion, and microvascular decompression, she experienced recurrent episodes of severe pain. At presentation, she was receiving pregabalin, carbamazepine, and fentanyl transdermal patch with limited efficacy and notable adverse effects. Transition to oxycodone, in combination with optimized pregabalin, carbamazepine, and venlafaxine, led to substantial pain relief and improved functionality. Hyponatremia secondary to high-dose carbamazepine was identified and corrected by dose adjustment. Conclusion: This case underscores the diagnostic challenges of glossopharyngeal neuralgia and highlights the importance of individualized, multimodal treatment strategies. While surgical interventions may offer partial benefit, adjunctive pharmacotherapy, including opioid therapy in refractory cases, can be essential for achieving adequate pain control.

Background: Microsurgical free-flap reconstruction has become essential for restoring form and function in pediatric head and neck defects, yet outcome data remain heterogeneous and often limited to technical survival. This single-center retrospective study evaluated 54 free-flap procedures performed in 46 pediatric patients (16 months–18 years) to assess clinical effectiveness using a standardized Treatment Effectiveness Score integrating flap viability, donor-site healing, and functional recovery. Methods: Recipient- and donor-site outcomes, swallowing, mastication, breathing, and mouth opening were systematically assessed, and age was analyzed as a modifying variable. Results: Overall flap survival reached 76% and mean Treatment Effectiveness Score in cases without flap loss was 89.7. Partial complications occurred in 37% of procedures, while donor-site morbidity was rare (5.6%). Full functional restoration across all domains was achieved in 80.4% of patients, with most impairments occurring in combined osseous and soft-tissue reconstructions. Age demonstrated no significant association with either flap survival or overall treatment effectiveness. Continuous postoperative Doppler monitoring facilitated early identification of vascular compromise and supported salvage attempts in selected cases. Conclusions: These findings support the safety and feasibility of pediatric microsurgical reconstruction across the age spectrum and demonstrate that composite outcome scoring provides a more comprehensive assessment than flap survival alone, offering a framework for standardized reporting in future studies.

Background: Pediatric mandibular reconstruction requires restoration of mandibular continuity while accounting for craniofacial growth, dental development, and long-term functional outcomes. Although vascularized osseous free flaps are widely used, the influence of defect characteristics and patient age on donor-site selection remains unclear. This study evaluated patterns of flap selection in relation to mandibular defect classification and patient age. Methods: This retrospective single-center cohort study included 75 patients aged 1–18 years who underwent microvascular mandibular reconstruction between 2011 and 2025. Donor sites included the fibula, iliac crest, and medial femoral condyle. Mandibular defects were classified according to the Brown classification. Associations between defect class, age, donor-site selection, and flap loss were analyzed. Results: The fibula flap was used most frequently (52.0%), followed by the iliac crest (44.0%) and medial femoral condyle (4.0%). Donor-site selection was significantly associated with Brown defect classification (p < 0.001). Age differed across donor-site groups, with fibula flaps used more often in younger patients and iliac crest flaps in older patients. However, after stratification by defect class, age-related differences were not statistically significant. Overall flap survival was 93.3%, and age was not associated with total flap loss. Conclusions: Donor-site selection showed a stronger association with defect characteristics than with patient age. Observed age-related patterns likely reflect differences in defect morphology. These findings support the clinical relevance of a defect-oriented framework for pediatric mandibular reconstruction; however, flap selection remains individualized and influenced by multiple patient- and surgeon-related factors.

Background: Reconstruction of maxillary defects in pediatric patients presents unique challenges related to craniofacial growth, functional rehabilitation, and long-term treatment planning. Although microvascular free-flap reconstruction is established in pediatric head and neck surgery, maxilla-specific data remain limited. This study aimed to describe donor-site selection patterns in pediatric maxillary microvascular reconstruction and to explore their relationship with patient age. Methods: This retrospective observational study included pediatric patients (aged 1–18 years) who underwent microvascular free-flap reconstruction of the maxilla between August 2011 and September 2025 at a single tertiary referral center. Clinical variables included age, defect characteristics, reconstruction timing, donor-site, and total flap loss. Donor-site selection patterns were analyzed in relation to patient age using nonparametric statistical methods. Results: Fifty-five patients were included. Overall flap survival was 81.82% (45/55). Donor-site selection demonstrated a significant association with patient age (p < 0.05). Younger children were more frequently reconstructed using soft-tissue flaps, whereas osseous flaps were more commonly used in older children and adolescents. No significant relationship was found between age and defect extent or reconstruction timing. Conclusions: In this single-center experience, pediatric maxillary reconstruction followed an age-adapted pattern, with soft-tissue flaps preferentially used in younger patients and osseous flaps more frequently selected in older children. These findings reflect differences in reconstructive priorities across developmental stages and support individualized planning in pediatric maxillary reconstruction. Age alone was not associated with total flap loss; however, this analysis was limited by the small number of flap loss events.

Background: Microvascular free flap reconstruction is an established method for the management of complex head and neck defects in pediatric patients. However, the influence of perioperative anesthetic management on flap outcome in this population remains insufficiently defined. The aim of this study was to evaluate the association between selected perioperative anesthetic factors and flap outcome in pediatric patients. Methods: This retrospective observational study included pediatric patients undergoing microvascular free flap reconstruction between August 2011 and July 2020. Of 80 screened patients, 56 met the inclusion criteria based on complete medical records. Demographic, surgical, and perioperative anesthetic variables were collected. Continuous variables were compared using the Mann–Whitney U test, and categorical variables using the chi-squared test with Yates’ correction. Correction for multiple testing was performed using the Benjamini–Hochberg false discovery rate procedure. Results: Complete flap survival was achieved in 50 patients (89.3%), while partial and total flap loss occurred in 3 patients each (5.4%). No significant associations with flap loss were identified for the type of anesthetic gas, opioid use, induction agents, intraoperative fluid therapy, diuresis, rocuronium dose, or operation time. Lower weight-adjusted doses of midazolam and propofol showed borderline unadjusted associations with flap loss; however, these differences did not reach statistical significance after correction for multiple testing. Patients with flap loss had a higher mean intraoperative body temperature compared to those with successful flap survival (36.65 °C vs. 36.05 °C; p < 0.05). Conclusions: In pediatric head and neck free flap reconstruction, most analyzed perioperative anesthetic factors were not associated with flap outcome. Dose-related findings for midazolam and propofol should be interpreted as exploratory and non-significant after correction for multiple testing, while higher intraoperative body temperature was associated with flap loss. However, these results are exploratory, cannot establish causality, and require confirmation in larger, preferably multicenter studies with adjustment for surgical and patient-related confounders.