The importance of mandibular position in microvascular mandibular reconstruction

The challenge of mandibular reconstruction rests in the difficulty of re-creating the intricate three-dimensional relationship of the oral cavity, thereby ensuring occlusal relationships, oral competence, and facial contour. Recent advances in microvascular surgery have made reliable transfer of autologous tissue possible, but successful reconstruction depends on accurate insetting of the bone flap. The authors reviewed their five years of experience with mandibular reconstruction and found six patients with a poor reconstructive result secondary to improper insetting of the bone flap. Anteromedially rotated and free-floating proximal mandibular segments appeared to be the most significant contributor to incorrect placement of the bone flap. Based on their findings, the authors devised a simple technique for stabilizing proximal mandibular segments.