Subtotal Mandibular Reconstruction Using an Intraoral Approach: Report of 2 Cases

In approaching extensive mandibular benign osseous lesions, the esthetic outcome is one of the first goals of the reconstructive surgeon. Reconstruction via an intraoral approach avoids facial incisions, preserves the perioral musculature, and reduces morbidity, giving the optimal esthetic and functional results. The mandible plays a significant esthetic and functional role in the face, especially in mastication, deglutition, and speech. In young patients, mandibular defects are usually approached with osseous reconstructions to allow future endosseous implant placement. Furthermore, when the anterior mandible is involved, bone restoration is mandatory because of the importance of this area from both esthetic and functional perspectives. Several bone-containing free flaps have been proposed, and fibula and iliac crest free flaps are usually considered the first choice for such reconstructions. In particular, when the resection involves a large part of the mandible, a fibula free flap is usually used because of the larger amount of bone provided, which is reliable for dental rehabilitation, and the minor donor site morbidity. As the limited field exposure does not allow precise preplating of the native mandible, a stereolithographic model is used to preoperatively model the titanium plate and achieve the best results, while shortening the surgery.