Function-oriented reconstruction of pediatric missile-related perioral and mandibular injury: a case report

A 10-year-old girl sustained devastating missile-related maxillofacial trauma during the Ukrainian war, resulting in loss of the lips, cheek, and mandible. Flap reconstruction in Russia had failed, resulting in severe scar contracture. The patient presented with profound dysfunction, including trismus, drooling, and gastrostomy dependence. Preoperative angiography identified recipient vessels outside the injury zone, enabling radial forearm free flap reconstruction with a titanium reconstruction plate contoured on a patient-specific three-dimensionally printed mandibular model. Postoperatively, maximal mouth opening improved, and the diet advanced from minimal liquids via a straw to a soft oral diet, reducing gastrostomy dependence. Oral competence partially recovered, with improvements in speech and nutrition. This case emphasizes the importance of preoperative planning for microvascular anastomosis and function-focused reconstruction to restore feeding, speech, and growth in pediatric patients with war-related facial trauma.