jaw reconstruction by free fibular transfer: emphasis on osteointegrated implants, TMJ and maxillary reconstruction

From December 1989 to September 1997 21 patients were treated for mandible reconstruction and 10 for maxilla reconstruction using the fibular flap. The age of patients ranged from 25 to 64, the length of the bone grafts from 7 to 25 cm. In 16 cases osseointegrated implants were used for denture rehabilitation; in 3 cases the reconstruction involved the TM joint. In the maxilla the fibula flap was used to reconstruct extreme atrophy of the alveolar process in 4 cases; to reconstruct a previous hemimaxillectomy in 3 cases and post-traumatic bone loss in 3 cases. Bone fixation was obtained by K-wires in 4 cases and miniplates in the remaining 27. The TM joint was reconstructed with an osteochondral graft from the second metatarsal head or an ear cartilage graft sutured on top of the fibula. In one case the homologous condyle conserved after tumor resection was used. The flaps were bone only (12 cases), bone plus muscle (15 cases) and osteocutaneous (4 cases). Average follow-up was 3–4 years. Twenty-eight flaps had no complications, with good functional and morphological results. One flap was lost because of infection, 1 flap was lost after 3 years due to a recurrence of malignancy; 1 flap had a segmental bone necrosis because partial devascularization occurred after hemostasis to stem major bleeding. Seventy-nine fixtures were placed, 47 into the new mandibles and 32 into the reconstructed maxillae. All implants have been well osseointegrated, except 1 removed at the time of surgery because of poor primary stability. Sixteen patients have had an implant-supported prosthesis. In our experience fibula is one of the most versatile flaps for jaw reconstruction, especially when osseointegration is planned or the TMJ and the maxilla need to be reconstructed.