{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T13:11:22Z","timestamp":1787663482215,"version":"build-2736575974"},"reference-count":44,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: This study evaluates the epidemiological characteristics and survival, functional, and esthetic outcomes of pediatric patients diagnosed with head and neck sarcoma (PHNS) who underwent individualized surgical treatment for local disease control and\/or for defect reconstruction. Methods: A cohort of 45 patients aged 0\u201318 years with histologically confirmed PHNS who underwent surgical resection and\/or reconstructive procedures was analyzed. Extracted variables included demographic data, tumor histology and stage, surgical margin status, and systemic therapy modalities. Reconstructive strategies were assessed, considering technique, sequencing, and total duration of treatment. Survival analysis was performed, focusing on both overall survival (OS) and event-free survival (EFS). Results: Rhabdomyosarcoma constituted the predominant diagnosis (19\/45), followed by Ewing sarcoma (7\/45) and chondrosarcoma (5\/45). The maxilla represented the most common primary site (18\/45), whereas orbital origin was the least frequent (3\/45). Complete surgical excision (R0) was achieved in 80.5% of resected cases. Margin status showed no statistically significant association with final outcome (p = 0.7786). In contrast, nodal metastasis, local recurrence, and distant dissemination were independently and collectively correlated with mortality. Survival analysis demonstrated a 3-year OS of 100% and an EFS of 79.8%, and a 5-year OS of 94.7% with an EFS of 70.7%. Conclusions: Implementation of an individualized surgical and reconstructive protocol was associated with effective local tumor control and favourable reconstructive outcomes. Oncologic prognosis was driven primarily by nodal involvement and recurrent or metastatic disease rather than margin status alone.<\/jats:p>","DOI":"10.3390\/jcm15093467","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T09:33:17Z","timestamp":1777627997000},"page":"3467","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Surgical Management of Pediatric Head and Neck Sarcoma: A Single-Centre Retrospective Analysis over a 10-Year Period"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6024-2947","authenticated-orcid":false,"given":"Patryk","family":"Ko\u0142odziejski","sequence":"first","affiliation":[{"name":"Department of Maxillofacial and Reconstructive Surgery for Children and Adolescents, Regional Specialized Children\u2019s Hospital, 18a Zolnierska Str., 10-561 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1696-8562","authenticated-orcid":false,"given":"Aleksandra","family":"Ko\u0142odziejska","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry, Faculty of Medicine, Medical University of Gda\u0144sk, 3c Sklodowska-Curie Str., 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9696-1284","authenticated-orcid":false,"given":"Tomasz","family":"Brzeski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology and Hematology, University of Warmia and Mazury in Olsztyn, Regional Specialized Children\u2019s Hospital, 18a Zolnierska Str., 10-561 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Borowiec","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial and Reconstructive Surgery for Children and Adolescents, Regional Specialized Children\u2019s Hospital, 18a Zolnierska Str., 10-561 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6096-5651","authenticated-orcid":false,"given":"\u0141ukasz","family":"Krakowczyk","sequence":"additional","affiliation":[{"name":"\u201cKlinika Nieborowice Sp. z o.o.\u201d, 5 Kasztanowa Str., 44-144 Nieborowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9200-2828","authenticated-orcid":false,"given":"Marcin","family":"Kozakiewicz","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery, Medical University of Lodz, 251 Pomorska Str., 92-213 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7605-2080","authenticated-orcid":false,"given":"Krzysztof","family":"Dowgierd","sequence":"additional","affiliation":[{"name":"Head and Neck Surgery Clinic for Children and Young Adults, Department of Clinical Pediatrics, University of Warmia and Mazury in Olsztyn, Regional Specialized Children\u2019s Hospital, 18a Zolnierska Str., 10-561 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.4065\/82.11.1409","article-title":"Sarcoma","volume":"82","author":"Skubitz","year":"2007","journal-title":"Mayo Clin. Proc."},{"key":"ref_2","unstructured":"Amin, M.B., Edge, S.B., Greene, F.L., Byrd, D.R., Brookland, R.K., Washington, M.K., Gershenwald, J.E., Compton, C.C., Hess, K.R., and Sullivan, D.C. (2017). AJCC Cancer Staging Manual, Springer. Available online: https:\/\/link.springer.com\/book\/9783319406176."},{"key":"ref_3","unstructured":"WHO Classification of Tumours Editorial Board (2025, September 20). Soft Tissue and Bone Tumours, Available online: https:\/\/publications.iarc.fr\/Book-And-Report-Series\/Who-Classification-Of-Tumours\/Soft-Tissue-And-Bone-Tumours-2020."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.bjps.2016.09.026","article-title":"The surgical management of head and neck sarcoma: The Newcastle experience","volume":"70","author":"Breakey","year":"2017","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.amjoto.2014.02.003","article-title":"Head and neck sarcomas: The UCLA experience","volume":"35","author":"Tajudeen","year":"2014","journal-title":"Am. J. Otolaryngol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1002\/hed.20232","article-title":"Multidisciplinary management of head and neck sarcomas","volume":"27","author":"Colville","year":"2005","journal-title":"Head Neck"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1001\/archotol.128.6.655","article-title":"Pediatric head and neck malignancies: US incidence and trends over 2 decades","volume":"128","author":"Albright","year":"2002","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/S0022-3468(96)90346-2","article-title":"Extremity sarcomas: An analysis of prognostic factors from the Intergroup Rhabdomyosarcoma Study III","volume":"31","author":"Andrassy","year":"1996","journal-title":"J. Pediatr. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1002\/(SICI)1097-0142(19980301)82:5<851::AID-CNCR8>3.0.CO;2-M","article-title":"Prognostic factors for patients with sarcomas of the pelvic bones","volume":"82","author":"Kawai","year":"1998","journal-title":"Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1002\/1097-0142(20000815)89:4<868::AID-CNCR20>3.0.CO;2-9","article-title":"Prognostic factors in head and neck soft tissue sarcomas","volume":"89","author":"Dudhat","year":"2000","journal-title":"Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1002\/1097-0142(19940101)73:1<187::AID-CNCR2820730132>3.0.CO;2-J","article-title":"Recurrence at the primary site in head and neck cancer and the significance of neck lymph node metastases as a prognostic factor","volume":"73","author":"Leemans","year":"1994","journal-title":"Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1177\/00220345320120050101","article-title":"Prosthesis of the mouth and face: A symposium","volume":"12","author":"Kazanjian","year":"1932","journal-title":"J. Dent. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/00006534-197901000-00012","article-title":"The pectoralis major myocutaneous flap: A versatile flap for reconstruction in the head and neck","volume":"63","author":"Ariyan","year":"1979","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/S0039-6109(16)35730-9","article-title":"The early history of the tubed pedicle flap","volume":"39","author":"Webster","year":"1959","journal-title":"Surg. Clin. N. Am."},{"key":"ref_15","first-page":"138","article-title":"The use of microvascular free flaps for soft tissue augmentation of the face in children with hemifacial microsomia","volume":"17","author":"Whitaker","year":"1980","journal-title":"Cleft Palate J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/0007-1226(81)90045-X","article-title":"Reconstruction of progressive facial hemi-atrophy by free vascularised dermis-fat flaps","volume":"34","author":"Shintomi","year":"1981","journal-title":"Br. J. Plast. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.jcms.2012.10.021","article-title":"Importance of patient-specific intraoperative guides in complex maxillofacial reconstruction","volume":"41","author":"Rohner","year":"2013","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/MOO.0000000000000437","article-title":"Impact of 3D virtual planning on reconstruction of mandibular and maxillary surgical defects in head and neck oncology","volume":"26","author":"Witjes","year":"2018","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1002\/micr.22229","article-title":"Simulated surgery and cutting guides enhance spatial positioning in free fibular mandibular reconstruction","volume":"35","author":"Yuhasz","year":"2015","journal-title":"Microsurgery"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s41199-016-0019-4","article-title":"Using 3D computer planning for complex reconstruction of mandibular defects","volume":"1","author":"Kirke","year":"2016","journal-title":"Cancers Head Neck"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1097\/01.scs.0000186306.32042.96","article-title":"Virtual planning of composite mandibular reconstruction with free fibula bone graft","volume":"16","author":"Eckardt","year":"2005","journal-title":"J. Craniofac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s00784-014-1291-5","article-title":"Virtual planning of complex head and neck reconstruction results in satisfactory match between real outcomes and virtual models","volume":"19","author":"Hanken","year":"2015","journal-title":"Clin. Oral Investig."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2172","DOI":"10.1002\/(SICI)1097-0142(20000501)88:9<2172::AID-CNCR25>3.0.CO;2-7","article-title":"Bone sarcomas of the head and neck in children","volume":"88","author":"Daw","year":"2000","journal-title":"Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.ejca.2021.04.007","article-title":"Non-parameningeal head and neck rhabdomyosarcoma in children, adolescents, and young adults: Experience of the European Paediatric Soft Tissue Sarcoma Study Group (EpSSG) RMS2005 study","volume":"151","author":"Glosli","year":"2021","journal-title":"Eur. J. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1016\/S0360-3016(00)00799-9","article-title":"Long-term effects in children treated with radiotherapy for head and neck rhabdomyosarcoma","volume":"48","author":"Paulino","year":"2000","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1002\/1097-0142(19860515)57:10<2070::AID-CNCR2820571032>3.0.CO;2-G","article-title":"Late effects after treatment of twenty children with soft tissue sarcomas of the head and neck","volume":"57","author":"Fromm","year":"1986","journal-title":"Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/S0344-0338(11)80700-4","article-title":"The pathologist and the residual tumor (R) classification","volume":"190","author":"Hermanek","year":"1994","journal-title":"Pathol. Res. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1002\/bimj.201700067","article-title":"Variable selection\u2014A review and recommendations for the practicing statistician","volume":"60","author":"Heinze","year":"2018","journal-title":"Biom. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1177\/0194599814545747","article-title":"Head and neck sarcomas: Analysis of the SEER database","volume":"151","author":"Peng","year":"2014","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"106495","DOI":"10.1016\/j.oraloncology.2023.106495","article-title":"The impact of surgical resection margins on outcomes for adults with head and neck osteosarcomas: A Canadian Sarcoma Research and Clinical Collaboration study","volume":"145","author":"Tzelnick","year":"2023","journal-title":"Oral Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Machavoine, R., Helfre, S., Bernier, V., Bolle, S., Leseur, J., Corradini, N., Rome, A., Defachelles, A.-S., Deneuve, S., and Bernard, S. (2022). Locoregional control and survival in children, adolescents, and young adults with localized head and neck alveolar rhabdomyosarcoma\u2014The French experience. Front. Pediatr., 9.","DOI":"10.3389\/fped.2021.783754"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e26876","DOI":"10.1002\/pbc.26876","article-title":"Long-term results in children with head and neck rhabdomyosarcoma: A report from the Italian Soft Tissue Sarcoma Committee","volume":"65","author":"Affinita","year":"2018","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S38","DOI":"10.1016\/j.joms.2024.06.064","article-title":"Prognostic indicators in pediatric head and neck sarcoma: A 17-year review","volume":"82","author":"Moshal","year":"2024","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ijporl.2017.06.003","article-title":"Pediatric head and neck bone sarcomas: An analysis of 204 cases","volume":"100","author":"Brady","year":"2017","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.anl.2010.12.004","article-title":"Clinical outcomes of rhabdomyosarcoma and Ewing\u2019s sarcoma of the head and neck in children","volume":"38","author":"Gradoni","year":"2011","journal-title":"Auris Nasus Larynx"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1245\/s10434-014-3870-8","article-title":"Prognostic factors and oncological outcomes of 122 head and neck soft tissue sarcoma patients treated at a single institution","volume":"22","author":"Park","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_37","first-page":"98","article-title":"Rhabdomyosarcoma of the head and neck in children","volume":"19","author":"Radzikowska","year":"2015","journal-title":"Contemp. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/SAP.0b013e3181e35e38","article-title":"Free anterolateral thigh flap in pediatric patients","volume":"66","author":"Gharb","year":"2011","journal-title":"Ann. Plast. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1097\/SAP.0000000000001549","article-title":"Long-term outcomes after pediatric free flap reconstruction","volume":"81","author":"Alkureishi","year":"2018","journal-title":"Ann. Plast. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1055\/s-0035-1544181","article-title":"Reconstruction of the pediatric midface following oncologic resection","volume":"31","author":"Garfein","year":"2015","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.jcms.2024.03.028","article-title":"Alloplastic temporomandibular joint replacement in the skeletally immature patient: A systematic review","volume":"52","author":"Sultan","year":"2024","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Sinn, D.P., Tandon, R., and Tiwana, P.S. (2021). Can alloplastic total temporomandibular joint reconstruction be used in the growing patient? A preliminary report. J. Oral Maxillofac. Surg., 79.","DOI":"10.1016\/j.joms.2021.08.152"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1007\/s12663-023-01874-y","article-title":"Dentinogenic ghost cell tumour in childhood involving the temporomandibular joint: Considerations and therapy","volume":"23","author":"Rustemeyer","year":"2024","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1002\/lary.27442","article-title":"Free flap transfer for pediatric head and neck reconstruction: What factors influence flap survival?","volume":"129","author":"Liu","year":"2019","journal-title":"Laryngoscope"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3467\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T09:50:52Z","timestamp":1777629052000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3467"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,1]]},"references-count":44,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093467"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093467","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,1]]}}}