Extended postoperative mandibular reconstructions due to orofacial disease involving the temporomandibular joint (TMJ) in immature patients remain a challenge as a result of ongoing growth, which is usually affected by the disease and treatment. Current reconstructive techniques based fully on alloplastic total joint replacement fail to meet fully the anatomical and functional requirements for the masticatory system and speech development. Fourteen children aged 12.6 ± 2.6 with tumors or congenital deformities affecting the mandible and TMJ were included in the study. Radical surgical treatment according to our own protocol was performed through microvascular anastomotic flap reconstruction of the soft tissues and bones, together with total TMJ custom replacements. Follow-up lasted 2–6 years. During the follow-up, increases in the mandible body (13% growth) and ramus (12% growth) were observed, both of which were related (p < 0.001). This is the first report concerning the immediate reconstruction of the mandible with ramus and total TMJ in children and adolescents that combines a free vascularized graft and total individual prosthesis of the TMJ. The presented technique enabled optimal function of the TMJ, growth of the mandible, and further rehabilitation of the patients. The technique was demonstrated to be safe, reliable, and provide good functional and cosmetic outcomes.

Functional and esthetic final reconstruction of the cleft maxilla is still challenging. Current reconstructive and augmentation techniques do not provide sufficient bone and soft tissue support for the predictable rehabilitation with dental implants due to presence of maxillary bone critical size defects and soft tissue deficiency, scaring and poor vascularity. In this article the protocol for the use of 3D virtual surgical planning and microvascular tissue transfers for the reconstruction and rehabilitation of cleft maxilla is presented. Twenty-five patients (8 male/17 female) aged 14–41 years old with cleft-associated critical size defects were treated by 3D-virtual planned microvascular tissue transfers taken either from fibula, iliac crest, radial forearm, or medial femoral condyle. Follow-up lasted 1–5 years. No significant bone resorption (p > 0.005) nor volume loss of the graft was observed (p = 0.645). Patients received final permanent prosthetic reconstruction of the anterior maxilla based on 2–5 dental implants, depending on the defect severity. This is the first study presenting the use of virtual planning in the final restoration of the cleft maxilla with microvascular tissue transfers and dental implants. Presented protocol provide highly functional and aesthetic results.

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/Objectives: This single-patient retrospective study evaluated the technical feasibility of serial infrared thermography (IRT) for intraoperative and postoperative surface-temperature documentation of free-flap skin islands and its descriptive concordance with clinical and vascular assessments. Methods: A 9-year-old boy with Nager syndrome undergoing bilateral temporomandibular joint reconstruction and soft-tissue reconstruction with an anterolateral thigh free flap divided into two skin islands was monitored intraoperatively and postoperatively. Thermograms were acquired using a FLIR T1020 camera (emissivity 0.98) under documented environmental conditions. Intraoperative and postoperative observations were interpreted separately, without normalisation between settings. Mean temperatures within manually delineated regions of interest and inter-island differences were analysed retrospectively and compared descriptively with documented clinical assessment, Doppler ultrasonography, and computed tomography angiography (CTA) findings. Results: Pallor prompted Doppler ultrasonography, followed by CTA; these showed absent right-perforator flow and non-visualisation of that perforator, respectively. The skin did not bleed after puncture. Thermography was performed after these tests and was not taken into account when making the decision about reoperation. IRT demonstrated temperature changes in both skin islands. At 49 h after the initial flap measurement, the mean surface temperature was 26.6 °C in the right skin island and 32.7 °C in the left (absolute difference, 6.1 °C). A focal area of relatively increased surface temperature “hot spot” was identified retrospectively within the viable left skin island; this qualitative observation was exploratory and was not based on a prespecified thermal threshold. Conclusions: Serial IRT was feasible and provided contactless thermal information retrospectively concordant with multimodal perfusion assessment. These findings are hypothesis-generating and do not establish earlier detection, diagnostic accuracy, or a universal thermal threshold; larger prospective studies are required.

Introduction: Primordial odontogenic tumor (POT) is an exceptionally rare benign mixed odontogenic neoplasm recognized as a distinct entity in the 2017 World Health Organization classification of head and neck tumors. Owing to its rarity and overlapping clinicopathological features with other odontogenic lesions, establishing the diagnosis before definitive treatment remains challenging. Case Report: We report the case of a 2-year-old boy presenting with rapidly progressive swelling of the left maxilla associated with facial asymmetry and orbital displacement. Initial incisional biopsy performed at another institution suggested odontogenic myxoma. Computed tomography and magnetic resonance imaging demonstrated a large, well-defined expansile lesion occupying the left maxillary sinus with extensive bone thinning, cortical perforation and compression of the orbital contents. Because of the lesion extent, ocular involvement, and the presumed diagnosis, subtotal maxillectomy with immediate soft tissue reconstruction using an anterolateral thigh free flap was performed. Histopathological examination of the entire surgical specimen established the final diagnosis of primordial odontogenic tumor. At 24 months of follow-up, no evidence of recurrence was observed, and visual function remained normal. Conclusions: This case illustrates the diagnostic limitations of incisional biopsy in biphasic odontogenic tumors and highlights the importance of integrating clinical, radiological, and histopathological findings. Although POT generally demonstrates benign biological behavior, extensive lesions involving critical anatomical structures may require individualized surgical management.

Introduction: Primordial odontogenic tumor (POT) is an exceptionally rare benign mixed odontogenic neoplasm recognized as a distinct entity in the 2017 World Health Organization classification of head and neck tumors. Owing to its rarity and overlapping clinicopathological features with other odontogenic lesions, establishing the diagnosis before definitive treatment remains challenging. Case Report: We report the case of a 2-year and 10-month-old boy presenting with rapidly progressive swelling of the left maxilla associated with facial asymmetry and orbital displacement. An initial incisional biopsy performed at another institution suggested odontogenic myxoma. Computed tomography and magnetic resonance imaging demonstrated a large, well-defined expansile lesion occupying the left maxillary sinus with extensive bone thinning, cortical perforation and compression of the orbital contents. Because of the extent of the lesion, ocular involvement, and the presumed diagnosis, subtotal maxillectomy was performed, followed by immediate soft tissue reconstruction using an anterolateral thigh free flap and reconstruction of the orbital floor with a titanium plate. Histopathological examination of the entire surgical specimen established the final diagnosis of primordial odontogenic tumor. At 24 months of follow-up, no evidence of recurrence was observed, and visual function remained normal. Conclusions: The mean age at diagnosis is approximately 11 years. Cases of POT previously described in the literature were lesions ranging in size from 0.8 × 0.8 × 0.8 cm to 9.0 × 7.0 cm. Most lesions occurred in the posterior mandible and were described as well-defined and unilocular, and an association with an unerupted tooth was reported in all 39 cases (100%). This case illustrates the diagnostic limitations of incisional biopsy in biphasic odontogenic tumors and highlights the importance of integrating clinical, radiological, and histopathological findings. Although POT generally demonstrates benign biological behavior, extensive lesions involving critical anatomical structures may require individualized surgical management.