An alternative approach for mandible reconstruction

The regeneration of bony defects of the mandible using free vascularized bone grafts has become a reliable procedure during the last few years. Various donor sites are available to provide vascularized bone grafts for mandibular reconstruction such as the fibula flap, the iliac flap, and the scapula flap; the fibula flap has become the most popular workhorse flap to reconstruct the lower jaw for extensive surgical defects. It is a challenge for head and neck reconstructive surgeons if the patient (mostly the manual worker) refuses to use fibular flap to reconstruct an extensive mandible defect or the patients have contraindication to harvest fibular flap. We have performed 7 cases using computer-aided design and computer-aided manufacturing prefabricated titanium mesh combined with autogenous iliac cancellous bone graft plus with/without boiled nontumorous mandible bone to reconstruct such cases. Primary wound healing was achieved in all patients without complication, and reconstructive complications were not observed during the follow-up period. The patients were satisfied with the results both esthetically and functionally. This preliminary clinical study and cases demonstrate that it is a feasible alternative method to reconstruct mandibular defects, especially when vascularized bone grafting is not available.