Functional mandibular reconstruction with double-barrel fibular flap and primary osseointegrated dental implants improve facial aesthetic outcome

Publication date: Available online 22 August 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Jie Chen, Ping Yin, Ning Li, Limeng Wu, Xinchun Jian, Canhua Jiang

Abstract

Introduction

Osseo-integrated dental implants in fibula free flaps can be used to reconstruct segmental mandibular defects resulting from head and neck resections. Double-barrel fibula flap (DBFF) has been applied as a modified method to overcome the insufficient width of fibula. This article describes DBFF with simultaneous dental implants placement as a superior method for esthetic mandibular reconstruction.

Methods

From 2012 to 2015, 26 patients underwent mandibular reconstruction with free fibula flap and immediate dental implant placement after segmental mandibulectomies. Among them 12 patients used DBFF while the other 14 patients used the conventional single barrel fibula flaps (SBFF). Palatal mucosal graft was performed if necessary. Functional and esthetic outcome was evaluated after 31 to 45 months' follow-up.

Results

All microvascular fibula transplantation were successful. All patients completed prosthodontic rehabilitation. The mean follow-up of patients after the reconstruction was 36.3 months (range: 31-45 months). The facial esthetic score was significantly higher in patients treated with DBFF than SBFF after 24 and 30 months (p<.05). No significant difference of marginal bone resorption between DBFF and SBFF (p>.05).

Conclusions

The one-stage surgical method is safe and reliable. DBFF significantly reduced the height discrepancy between the naïve and neomandible and achieve a better lower face esthetic outcome than SBFF. Osseointegrative dental implantation was adequate to achieve satisfactory dental rehabilitation in DBFF.

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