Novel Bicomposite Flow-through Osteochondral Free Flap for Mandibular and Condylar Reconstruction

Mandibular reconstruction in pediatric patients presents significant challenges due to anatomical complexity, functional demands, and considerations for future growth. This case report introduced a novel reconstructive technique, bicomposite flow-through osteochondral joint salvage therapy, applied in a 16-year-old boy undergoing hemimandibulectomy for odontogenic myxoma. The benign but locally aggressive tumor required resection while preserving the ipsilateral condyle. To reconstruct the resulting defect and support temporomandibular joint function, we used a flow-through fibula free flap combined with a medial femoral condyle (MFC) periosteal flap. Using virtual surgical planning and computer-aided design, a left fibula flap was harvested and contoured with a prefabricated osteotomy template. A right MFC periosteal free flap was also harvested and wrapped around the preserved condyle, then fixated to the fibular construct with a miniplate. The reconstruction was secured to the remaining mandible with a rigid plate, and microvascular anastomoses were performed to ensure flap viability. Postoperatively, the patient recovered well, with progressive improvement in function. By 6 months, he had full, pain-free mouth opening, and imaging demonstrated condylar remodeling. Traditional fibula flaps are considered the gold standard for mandibular reconstruction; however, in pediatric patients, using them to reconstruct the temporomandibular joint carries risks of bone resorption and unpredictable growth. The bicomposite flow-through osteochondral joint salvage therapy technique addresses these concerns by incorporating vascularized periosteal tissue from the MFC, promoting healing and minimizing complications such as ankylosis. This innovative strategy offers a tailored solution for complex pediatric mandibular defects, especially when the native condyle can be preserved.