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A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
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Severe Crossbite: A Sequelae For Free Fibula Flaps For Mandibular Reconstruction.

Samuel Fleisher1, Neil McGowan, Stanley Smith

  • 1The Mount Sinai Hospital, New York, NY.

The Journal of Craniofacial Surgery
|May 1, 2026
PubMed
Summary

Free fibula flap reconstruction is common for mandibular defects. However, complications like crossbite can still occur, necessitating further evaluation and management in oral surgery patients.

Keywords:
Crossbitefibula free flapodontogenic keratocystpostoperative sequelae

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Reconstructive Surgery
  • Biomaterials Science

Background:

  • Free fibula flaps are increasingly favored for mandibular reconstruction due to their versatility and reliability.
  • Despite surgical advancements, patients undergoing mandibular reconstruction with free fibula flaps face risks of early and late-onset complications.
  • Odontogenic keratocyst (OKC) is a developmental tumor that can necessitate extensive mandibular resection.

Purpose of the Study:

  • To present a case study of a patient experiencing a severe crossbite following mandibular reconstruction with a free fibula flap.
  • To highlight potential complications associated with free fibula flap reconstructions in the mandible.
  • To discuss the evaluation and management of malocclusion after oncologic or reconstructive surgery.

Main Methods:

  • Case report of a 69-year-old male patient.
  • Review of the patient's medical history, including odontogenic keratocyst (OKC) resection and free fibula flap reconstruction.
  • Clinical examination for evaluation of severe crossbite and assessment of mandibular alignment.

Main Results:

  • The patient presented with a severe crossbite, indicating a significant complication post-mandibular reconstruction.
  • The crossbite potentially impacts masticatory function and occlusion, requiring further investigation.
  • This case underscores the persistent challenges in achieving ideal functional and aesthetic outcomes after complex reconstructive procedures.

Conclusions:

  • Free fibula flap reconstruction, while effective, can lead to late-onset complications such as malocclusion.
  • Comprehensive post-operative evaluation is crucial for identifying and managing complications like severe crossbite.
  • Further research is needed to optimize surgical techniques and post-operative care to minimize long-term complications in mandibular reconstruction.