Pediatric Mandibular Reconstruction Using Cadaveric Tibial Allograft and Cellular Bone Allograft (ViviGen ® )

Abstract

This report describes mandibular reconstruction in a 4-year-old male with recurrent trabecular juvenile ossifying fibroma. Following wide segmental mandibulotomy with periosteal preservation, a 6-cm parasymphyseal defect was reconstructed using a cadaveric tibial allograft combined with a cellular bone allograft. Imaging demonstrated progressive remodeling with complete osseous mandibular arch continuity at 22 months, and excellent function and facial harmony were observed on clinical follow-up to 42 months. This report reviews the paucity of current literature on pediatric mandibular reconstruction using cellular bone allografts and highlights its potential to achieve durable, growth-compatible pediatric mandibular reconstruction.

Keywords

pediatric mandibular reconstruction cellular bone allograft viable bone allograft juvenile ossifying fibroma

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References

Phillips

Rechner

Tompson

. Mandibular growth following reconstruction using a free fibula graft in the pediatric facial skeleton. Plast Reconstr Surg. 2005;116(2):419‐424. doi:10.1097/01.prs.0000172677.71629.10

Hintze

Afshar

Taghinia

Labow

Green

Robson

Marcus

Mack

Perez-Atayde

Rahbar

. A multi-disciplinary team approach to pediatric malignant mandibular tumors. Int J Pediatr Otorhinolaryngol. 2023;168(8):111547. doi:10.1016/j.ijporl.2023.111547

Joy

Liao

Magdycz

Parulis

Thompson

. Diagnosis and treatment of a benign pediatric mandible tumor. Plast Reconstr Surg Glob Open. 2019;7(10):e2452‐e2452. doi:10.1097/GOX.0000000000002452

Titinchi

. Juvenile ossifying fibroma of the maxillofacial region: Analysis of clinico-pathological features and management. Medicina oral, patología oral y cirugía bucal. 2021;26(5):e590‐e597. doi:10.4317/medoral.24592

Han

Zhang

Yang

Tian

Wang

Zhu

Yang

Sun

Zhang

, et al. Juvenile ossifying fibroma of the jaw: A retrospective study of 15 cases. Int J Oral Maxillofac Surg. 2016;45(3):368‐376. doi:10.1016/j.ijom.2015.12.004

Albert

, Payne

, Brady

, Wright

. Craniofacial changes in children-birth to late adolescence. ARC Journal of Forensic Science. 2019;4(1):1–19. doi:10.20431/2456-0049.0401001

Benoit

Vargas

Bhattacharyya

McGill

Robson

Ferraro

Didas

Labow

Upton

Taghinia

, et al. The presentation and management of mandibular tumors in the pediatric population. Laryngoscope. 2013;123(8):2035‐2042. doi:10.1002/lary.24020

Slijepcevic

Wax

Hanasono

Ducic

Petrisor

Thomas

Shnayder

Kakarala

Pipkorn

Puram

, et al. Post-operative outcomes in pediatric patients following facial reconstruction with fibula free flaps. Laryngoscope. 2023;133(2):302‐306. doi:10.1002/lary.30219

Firriolo

Dang

Nuzzi

Caldroney

Labow

. Outcomes after free fibula flaps for pediatric mandibular reconstruction: A systematic review. J Am Coll Surg. 2019;229(4):S226‐S227. doi:10.1016/j.jamcollsurg.2019.08.497

10.

Malloy

Dronkers

Firriolo

Nuzzi

Koudstaal

Padwa

Taghinia

Labow

. Outcomes following microvascular mandibular reconstruction in pediatric patients and young adults. Plast Reconstr Surg Glob Open. 2020;8(11):e3243‐e3243. doi:10.1097/GOX.0000000000003243

11.

Shahzad

Henderson

Matros

Cordeiro

. Long-term growth, functional, and aesthetic outcomes after fibula free flap reconstruction for mandibulectomy performed in children. Plast Reconstr Surg Glob Open. 2022;10(7):e4449. doi:10.1097/GOX.0000000000004449

12.

Gleizal

Revol

Bouletreau

Sailhan

Freidel

Breton

. Free fibular flaps in children: Morbidity of the donor site and pitfalls to avoid. Rev Stomatol Chir Maxillofac. 2005;106(6):349‐351. doi:10.1016/s0035-1768(05)86058-9

13.

Barla

Polirsztok

Peltié

Jouve

J-L

Legré

Dautel

Barbary

Journeau

. Free vascularised fibular flap harvesting in children: An analysis of donor-site morbidity. Orthop Traumatol Surg Res. 2017;103(7):1109‐1113. doi:10.1016/j.otsr.2017.05.009

14.

Shahzad

. Pediatric mandible reconstruction: Controversies and considerations. Plast Reconstr Surg Glob Open. 2020;8(12):e3285‐e3285. doi:10.1097/GOX.0000000000003285

15.

Akakpo

Iobst

Old

Grischkan

. Long-term follow-up with mention of complications in pediatric microvascular mandibular reconstruction. Int J Pediatr Otorhinolaryngol. 2018;105(2):154–157. doi:https://doi.org/10.1016/j.ijporl.2017.12.022

16.

Nabil

. A clinical study on the effect of new curved paediatric segment transfer distraction osteogenesis for symphyseal mandibular reconstruction. Egypt J Oral Maxillofac Surg. 2015;6(1):21‐25. doi:10.1097/01.OMX.0000459075.32503.d6

17.

Liu

Chen

Yan

Ping

. Mandible reconstruction with transport-disc distraction osteogenesis in children of deciduous dentition. Int J Oral Maxillofac Surg. 2012;41(10):1223‐1228. doi:10.1016/j.ijom.2012.04.021

18.

Disler

Hassanzadeh

Vecchiotti

Marston

Scott

. Complications of pediatric mandibular distraction osteogenesis: A comparison of internal and external devices. Fac Plast Surg Aesthet Med. 2025;27(1):44‐46. doi:10.1089/fpsam.2024.0128

19.

Okoturo

. Review of the literature on the current state of periosteum-mediated craniofacial bone regeneration. Craniomaxillofac Trauma Reconstr. 2023;17(3):253‐262. doi:10.1177/19433875231214068

20.

Steiger

Journeau

Lascombes

. The role of the periosteal sleeve in the reconstruction of bone defects using a non-vascularised fibula graft in the pediatric population. Orthop Traumatol Surg Res. 2017;103(7):1115‐1120. doi:10.1016/j.otsr.2017.05.027

21.

Fernandes

Fattahi

Steinberg

. Costochondral rib grafts in mandibular reconstruction. Atlas Oral Maxillofac Surg Clin. 2006;14(2):179‐183. doi:10.1016/j.cxom.2006.05.007

22.

Bauder

Mitchell

Swanson

Taylor

Bartlett

. Long-Term growth of costochondral rib grafts in mandibular reconstruction for craniofacial microsomia. Plast Reconstr Surg. 2015;136(4S):44‐45. doi:10.1097/01.prs.0000472331.37792.4f

23.

Liu

Odono

Wlodarczyk

Garg

Hammoudeh

. Unique techniques utilizing rib grafts for mandibular reconstruction in the pediatric population. J Craniofac Surg. 2021;32(5):1780‐1784. doi:10.1097/SCS.0000000000007440

24.

Eckardt

Barth

E-L

Berten

Gellrich

N-C

. Pediatric mandibular resection and reconstruction: Long-term results with autogenous rib grafts. Craniomaxillofac Trauma Reconstr. 2010;3(1):25‐32. doi:10.1055/s-0030-1249371

25.

Tahiri

Chang

Tuin

Paliga

Lowe

Taylor

Bartlett

. Costochondral grafting in craniofacial microsomia. Plast Reconstr Surg. 2015;135(2):530‐541. doi:10.1097/PRS.0000000000000914

26.

Gianulis

Wetzell

Scheunemann

Gazzolo

Sohoni

Moore

Chen

. Characterization of an advanced viable bone allograft with preserved native bone-forming cells. Cell Tissue Bank. 2023;24(2):417‐434. doi:10.1007/s10561-022-10044-2

27.

Somers

Vitale

Dunklebarger

Dadzie

Gociman

. Successful grafting with allogenic bone following benign pediatric mandibular tumor removal. Plast Reconstr Surg Glob Open. 2025;13(6):e6830. doi:10.1097/GOX.0000000000006830

28.

Ferretti

Ripamonti

. Long term follow-up of pediatric mandibular reconstruction with human transforming growth factor-β3. J Craniofac Surg. 2020;31(5):1424‐1429. doi:10.1097/SCS.0000000000006568

29.

Melville

Tran

Bhatti

Manon

Young

Wong

. Is reconstruction of large mandibular defects using bioengineering materials effective? J Oral Maxillofac Surg. 2020;78(4):661.e1‐661.e29. doi:10.1016/j.joms.2019.11.024

30.

Alfi

Hassan

East

Gianulis

. Immediate mandibular reconstruction using a cellular bone allograft following tumor resection in a pediatric patient. FACE. 2021;2(4):490‐495. doi:10.1177/27325016211057287

31.

Alfi

Coppelson

Caroline

Huang

. Treatment of severe mandibular hypoplasia using ViviGen Formable® cellular bone matrix combined with custom intraoral guides and plates in two patients. https://wwwlifenethealthorg//sites/default/files/68-20-325_0pdf.

32.

Marlière

DAA

Medeiros

dos Santos

Resende

ZTA

de Andrade

BAB

. Surgical approach for a rare case of bilateral trabecular juvenile ossifying fibroma in the mandible. J Oral Maxillofac Surg Med Pathol. 2024;36(6):866‐871. doi:10.1016/j.ajoms.2024.04.006

33.

Health

. ViviGen® cellular bone matrix technical monograph. https://wwwlifenethealthorg/sites/default/files/files/68-40-254%20Technical%20Monographpdf.

34.

Bae

Zhao

Kanim

LEA

Wong

Delamarter

Dawson

. Intervariability and intravariability of bone morphogenetic proteins in commercially available demineralized bone matrix products. Spine. 2006;31(12):1299‐1306. doi:10.1097/01.brs.0000218581.92992.b7

35.

Wildemann

Kadow-Romacker

Haas

Schmidmaier

. Quantification of various growth factors in different demineralized bone matrix preparations. J Biomed Mater Res A. 2007;81A(2):437‐442. doi:10.1002/jbm.a.31085

36.

Marschall

Davis

Jones

Kushner

. Are cellular bone matrix allografts a viable option for mandibular tissue engineering and reconstruction? J Oral Maxillofac Surg. 2024;82(9):1163‐1175. doi:10.1016/j.joms.2024.05.040

37.

Carlson

Liebman

Bak

Dougherty

Mark

. Reconstruction of composite mandible defects using a cellular bone allograft and soft tissue free flap coverage. Craniomaxillofac Trauma Reconstr. 2024;17(4):NP21‐NP30. doi:10.1177/19433875241237920

38.

Ryu

Abraham

Polido

. Treatment of mandibular non-union using patient specific crib cage plates and cellular bone allograft: A case report. Craniomaxillofac Trauma Reconstruct Open. 2021;6(6):3–29. doi:10.1177/24727512211005949

39.

Kushner

Harlan

Way

. Mandibular reconstruction using ViviGen Formable Cellular Bone Matrix following ameloblastoma resection. https://wwwlifenethealthorg/sites/default/files/files/68-20-255pdf.

40.

Smith

Sharma

Bluma

. Surgical repair of a mandibular angle fracture with fibrous union using ViviGen® cellular bone matrix. https://wwwlifenethealthorg//sites/default/files/68-20-272pdf.