Functional and Aesthetic Osseous Free Flap Mandible Reconstruction Using a Low-cost Method: Long-term Results

Mandibular segment loss due to tumoral resection or infectious sequelae causes functional alterations with disorders in mastication, swallowing, speech, and aesthetic alterations with facial asymmetry due to deformity secondary to soft tissue collapse. Reconstructive treatment should recover function and aesthetics. This paper presents a low-cost method of mandibular reconstruction in a series of 6 patients with different years of follow-up (average follow-up time of 11.6 years) using the fibula and scapula free flaps. METHODS: Five female patients and 1 male patient received mandibular reconstruction using osseous free flaps, 5 with the fibula and 1 with the scapula osseous free flap. The patient’s ages at the time of surgery ranged from 8 to 62 years (mean 33.1 years). Stainless steel wire was used as the osteosynthesis material, with intermaxillary fixation for 40 days postoperatively and masticatory rehabilitation using mucodental-supported prostheses. RESULTS: To evaluate the aesthetic result and the facial symmetry, a questionnaire and the photographs of all the cases were sent to 8 plastic surgeons. The functional result was evaluated in 5 of the 6 patients using the Spanish version of the Oral Health Impact Profile. All flaps survived, dental occlusion was achieved in all patients, no tumors recurred, masticatory function was normal without swallowing or speech alterations, and the transplanted bone hypertrophied and spontaneously remodeled, providing facial symmetry with good aesthetic results. CONCLUSION: We present a low-cost and universally applicable mandibular reconstruction method, with long-term follow-up and good aesthetic and functional results.