Mandibular reconstruction with local live vascularised bone transfer

There are different methods to provide a skeletal support for mandibular reconstruction following the trauma or ablation for tumor in head and neck region. These methods vary from complicated techniques like vascularised free bone grafts to methods like free bone grafts, local vascularised bone grafts, cadaveric irradiated bone grafts and alloplastic material spacers including silastic rubber, polyvinyl plastics, ceramics, hydroxylapatite or metal. The technique employed solely depends upon many factors like expertise available, existing infrastructure, the available time factor and complexity of the defects including the type and extent of tissue loss in the particular patient. The sliding mandibulectomy is a simple method of mandibular reconstruction. This surgical technique is indicated for repairing short mandibular defects up to 9 cm in overall length including the mandibular arch for which extra vertical osteotomies are needed to bend the segment. More so it has its value in patients with poor prognosis and poor general conditions in whom longer and complicated mandibular reconstruction procedures with free vascularised bone flaps are not advisable. This article describes different types of sliding osteotomies used to harvest live bone flaps for rebuilding the mandibular defects including the arch of the mandible for patients who have undergone malignant tumor ablation. Primary reconstruction for the mandibular skeletal support was obtained in 18 cases with vascularised live-bone graft through various sliding osteotomies in different combinations. Complications, failures and success rate of sliding mandibulectomies and osteotomies have been analyzed and discussed in detail.