Sagittal split osteotomy on the previously reconstructed mandible with fibula free flap

The fibula free flap offers several advantages in mandibular reconstruction, including an optimal length and bone quality for dental implantation; therefore, the use of this flap has become a method of choice for mandibular reconstruction. Although the development of computer-assisted surgical planning has increased the accuracy of mandibular reconstruction, some unexpected outcomes still occur in clinical settings. The patient in this report underwent mandibular reconstruction with the fibula free flap because of mandibular resection resulting from an ameloblastoma. However, unexpected movement of the grafted fibula bone had been observed, and we could not achieve a proper occlusal relationship even with implant-supported prosthesis. To resolve this problem, we corrected the position of previously grafted fibula and implants by using orthognathic surgery: sagittal split osteotomy on body and angle area and vertical osteotomy on the mandibular symphysis. After the orthognathic surgery at the previously reconstructed mandible with fibula free flap, a favorable and stable occlusal relationship could be achieved. The result demonstrated that the sagittal split osteotomy at the previous fibula free flap site can be successfully carried out to establish the proper occlusion.