Innovative 1 Fibula-2 Segmental Mandibular Reconstruction with Second Orthognathic Surgery for Bilateral Mandibular...

Patients with bilateral mandibular resorption and malunion after bilateral sagittal split osteotomy may present with an anterior open bite, chin retrusion, and facial deformity, necessitating a second orthognathic surgery and jaw reconstruction. This rare complication with an unclear pathogenesis requires careful selection of a repair technique to manage the discontinuous mandibular defects. Concealed surgical incisions, fewer operations, high success rates, and accurate outcomes are key goals. In the current method, virtual surgery for occlusion correction and condyle and mandibular ramus repositioning was used to assess the extent of bilateral defects. After weighing all reconstructive options, 2 separate vascularized fibula free flaps, prepared from a single fibular donor site, were selected for bilateral reconstruction. To effectively address intraoperative changes and enhance the contact area between the fibular segments and mandibular rami, a sliding design, modified step-cut osteotomy, and length-gradient titanium plates were adopted. With the aid of 3D-printed osteotomy guides and titanium plates, the surgical procedure was performed successfully according to the predetermined design through bilateral Risdon incisions. Favorable postoperative healing, a stable occlusal relationship, a well-formed mandible, and improved facial aesthetics were successfully achieved at a 2-year follow-up.