Segmental mandibular resection and reconstruction using a multidisciplinary approach in adolescent and young adult patients: A case of Ewing sarcoma with a eight-year follow-up

Ewing sarcoma (ES) is a rare malignant tumor, particularly in the head and neck region. Its incidence tends to be higher in pediatric patients than in adults. Occasionally, curative treatment of ES requires extensive resection of the primary lesion, which can result in postoperative aesthetic or functional disorders. In recent years, advances have been made in reconstructive surgery of the maxillofacial region. Broad mandibular defects are a prime indication for several types of vascularized free bone grafts. Similarly, the treatment of ES has progressed in the field of systemic chemotherapy. We report a multidisciplinary surgical case of ES in the mandible of a 12-year-old patient who underwent extensive mandibular resection and fibula free flap (FFF) reconstruction with preoperative and postoperative chemotherapy. In brief, after conducting a multidisciplinary clinical conference, perioperative chemotherapy was planned by pediatric oncologists, and the operation was performed by a head and neck cancer team consisting of head and neck, oral and maxillofacial, and plastic surgeons. Five months after the operation, prosthodontists applied an intraoral prosthesis. The reconstructed mandible demonstrated good development, and the quality of life was maintained both aesthetically and functionally for eight years after treatment. Our efficient multidisciplinary medical collaboration demonstrated that mandibular reconstruction using FFF is a suitable method for treating pediatric patients and leads to long-term survival with satisfactory outcomes.