Digitally Guided Intraoral Segmental Mandibulectomy and Fibula Flap Reconstruction for Locally Invasive Odontogenic...

Radical treatment of ameloblastoma and other benign locally invasive odontogenic tumors frequently requires mandibular segmentectomy followed by functional reconstruction. Conventional reconstruction is typically performed through an extraoral approach to obtain sufficient exposure; however, this technique often results in visible facial scarring, extensive soft-tissue dissection, and potential injury to the marginal mandibular branch of the facial nerve. This protocol describes a reproducible digitally guided workflow for mandibular segmental resection and reconstruction using a free vascularized fibula flap performed entirely through an intraoral approach. Preoperative imaging data are imported into virtual surgical planning software to construct three-dimensional models of the mandible and fibula. Resection margins and fibular osteotomies are simulated digitally, enabling the fabrication of patient-specific osteotomy guides and pre-shaped reconstruction plates. During surgery, the mandibular tumor is exposed and resected via a strictly intraoral incision with the assistance of the customized cutting guide. Simultaneously, a second surgical team harvests and shapes the fibula flap according to the digital plan. The fibular segments are then transferred to the mandibular defect, and microvascular anastomosis is performed through a minimally invasive buccal window, restoring vascular supply and mandibular continuity without external incisions. This technique is particularly suitable for patients with benign or locally aggressive mandibular tumors who prioritize scar-free reconstruction. However, it is not recommended for cases with severe trismus, extensive soft-tissue invasion, or those requiring cervical lymph node dissection. Overall, the protocol provides a reproducible framework for integrating digital surgical planning with minimally invasive intraoral mandibular reconstruction.