Classification of mandible defects and algorithm for microvascular reconstruction
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Updated: Apr 15, 2026
A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
Benjamin D Schultz1, Michael Sosin, Arthur Nam
1Baltimore, Md.; and New York, N.Y. From the Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center; the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the University of Maryland School of Medicine; and the Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery.
Background:
Composite mandibular tissue loss results in significant functional impairment and cosmetic deformity. This study classifies patterns of mandibular composite tissue loss and describes a microvascular treatment algorithm.
Methods:
A retrospective review of microvascular composite mandibular reconstruction from July of 2005 to April of 2013 by the senior surgeon at the R Adams Cowley Shock Trauma Center and at The Johns Hopkins Hospital yielded 24 patients with a mean follow-up of 17.9 months. Causes of composite mandibular defects included tumors, osteoradionecrosis, trauma, infection, and congenital deformity. Patients with composite tissue loss were classified according to missing subunits.
Results:
A treatment algorithm based on composite mandibular defects and microvascular reconstruction was developed and used to treat 24 patients. A type 1 defect is a unilateral dentoalveolar defect not crossing the midline and not extending into the angle of the mandible. A type 2 defect is a unilateral defect extending beyond the angle. A type 3 defect is a bilateral defect not involving the angles. A type 4 defect is a bilateral defect with extension into at least one angle. Type 2 defects were the predominant group. Patients had microvascular reconstruction using either fibula flaps (n = 19) or iliac crest flaps (n = 5). Complications included infection, partial necrosis, plate fracture, dehiscence, and microvascular thrombosis.
Conclusion:
This novel classification system and treatment algorithm allows for a consistent and reliable method of addressing composite mandibular defects and focuses on recipient vasculature and donor free flap characteristics.
