Technique

The aim of maxillary or mandibular reconstruction must be to restore not only aesthetics but also complete oral function. Cortical bone thickness, height, and bicortical structure of the fibula shaft is ideal for long-term implant-borne prosthetic rehabilitation. Fibular cortical thickness is superior with respect to the iliac crest or the scapula crest. The efficacy of dental implants placed into free fibula flaps for orofacial reconstruction has been thoroughly proved. Some authors have reported the possibility of inserting implants into the free fibula flap during the primary reconstruction. The major disadvantage of immediate implant insertion concerns the high possibility of misalignment of the fixtures. The use of oral implants in irradiated tissue is not considered to be contraindicated. The timing of the implantation procedure, with regard to the effects of irradiation on the jawbone, remains inconclusive for lack of scientific evidence. Typically, dental implants are placed 6–12 months after radiation therapy. The fibula flap is commonly harvested as osteocutaneous flap, so that a skin paddle is harvested with the fibula bone graft. The skin paddle is bulky, much thicker than the gingiva, not fixed to the bone by the periosteum, and not keratinized. Several techniques are used in soft-tissue management after a fibula vascularized graft, such as skin graft, mucosa graft, or biological membranes.