Mandibular Reconstruction, State of the Art

SUMMARY: Mandibular bone loss can result in severe aesthetic and functional consequences for the patient, posing a challenge to the reconstructive maxillo-facial surgeon. Advent of microvascular surgery revolutionized mandible reconstruction introducing the possibility to transfer vascularized bone and soft tissues with high success rate. Major donor sites are the fibula, iliac crest and scapula. Planning of the reconstruction and advantages and disadvantages of the different reconstructive methods are discussed. The iliac crest provides an excellent bone for mandibular reconstruction but has some limits concerning length and versatility of soft tissues. The fibula permits the repair of large mandibular defects due to its length while the scapular osteocutaneous flap allows for the reconstruction of limited bone defects associated with large soft tissue defects. Nonvascularized reconstructive methods are associated with higher failure rates but can be considered in selected cases.