Reconstruction of mandible defect with folded free fibular flap

Mandibular defects directly affect a patient’ facial features, masticatory and articulation. This study has analyzed 41 patients with mandibular ameloblastoma who underwent a partial mandibulectomy and reconstruction by folding the free fibular flap. In the preoperative and postoperative (6 months and 24 months after surgery), the QOL of these patients was assessed by using the University of Washington Quality of Life Questionnaire (UW-QOL) and the medical outcome study short form-36 (SF-36) questionnaires. The sf-36 survey showed that body pain, general health, and health changes decreased significantly at 6 months after surgery, but the mean score at 24 months after surgery all exceeded that shown before surgery. The UW-QOL survey showed that chewing, speech and taste had significantly changed in the 6 months after the surgery, and the difference was statistically significant 24 months after the surgery. The total score of the patients almost recovered to the preoperative level at 24 months after the surgery. The folded free fibular flap is an ideal selection for the reconstruction of oral defects after cancer resection. In using this flap, the basic social need of patients after surgery can be satisfied. The folded free fibular flap can improve the patients’ QOL.

Reconstruction of Mandible with Free Fibula Flap:Report of Three Cases

Mandibular reconstructive surgery has changed in the recent times with the introduction of advanced techniques. Mandibular reconstruction a challenge for the reconstructive surgeons, is now reliable and highly successful with excellent long-term functional and aesthetic outcomes using vascularised fibular flap in various mandibular pathologies. The ideal reconstruction should restore the anatomic contour, speech, mastication and aesthetics. The free vascularised fibular flap is the primary source of bone for reconstruction of large segmental mandibular defects due to its rich vascularity. We present three cases of segmental mandibular defects reconstructed primarily with vascularised free fibular flap without skin paddle which were followed up for two years.

Wide Excision with Immediate Reconstruction of the Mandible Using Free Fibular Flap in Ameloblastoma of the Mandible—A Need of Time: Our Experience of 37 Cases

Background Ameloblastoma is a benign yet locally aggressive odontogenic tumor of the jaw with high recurrence rates. Despite many studies, the search is still on for the treatment approach which can render the acceptable recurrence rates with good functional and esthetic results. Methods In this prospective study, we operated on 37 patients of mandibular ameloblastoma between 2009 and 2018. Two patients were treated with curettage and chemical sterilization of the cavity. Resection of a tumor with a 2-cm margin was performed in the rest of 35 patients. The mandibular defect was primarily reconstructed with the microvascular free fibular flap in 29 patients. Results The follow-up ranged from 6 months to 7.7 years with a mean of 5.1 years. A tumor recurred within a year in all two patients (100%) treated with curettage. Out of 35 radical excisions, only one patient (2.85%) developed recurrence 3 years after the disease-free interval. Good mouth opening, intelligible speech, satisfactory lower jaw shape, and facial profiles were achieved in all 29 patients who were treated with primary free fibular flap. Conclusion We prefer wide excision with 2-cm margins on each side of a tumor with the primary reconstruction of the mandible in all cases of mandibular ameloblastoma. The free fibular microvascular flap is our treatment of choice as all defects of the mandible can be reconstructed with the free fibular flap. Wide excision is the key to prevent a recurrence.