Innovative one fibula - two segmental mandibular reconstruction with a second orthognathic surgery for bilateral...

Patients with bilateral mandibular resorption and malunion after bilateral sagittal split osteotomy (BSSO) presented with an anterior open bite, chin retrusion, and facial deformity, necessitating a second orthognathic surgery and jaw reconstruction. Due to the rarity and unclear etiology of this complication, careful selection of repair techniques is imperative for managing such discontinuous mandibular defects. Patient demands, such as concealed surgical incisions, fewer operations, high success rates, and accurate outcomes, should be considered, specifically in young females. Following virtual surgery for occlusion correction, as well as condyle and mandibular ramus repositioning, the extent of bilateral defects can be assessed. After weighing all reconstructive options, two separate vascularized fibula free flaps, prepared from a single fibular donor site, were selected for bilateral reconstruction. To effectively address intraoperative changes and enhance 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 successfully performed 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 two-year follow-up.