[Microsurgical reconstruction of the mandible]

The authors present two clinical cases of mandibular reconstruction using free vascularized bone grafts and dental osseointegrated implants. A wide discussion about the different techniques of reconstruction is reported. Several factors like the clinical history, age, general conditions of patient's health can influence the choices of the surgeon. The characteristics of the different donor sites are described, so the advantages and disadvantages of the different free microvascular flaps are analyzed. According to the authors not only the technical aspects of microsurgery but also a good choice of the right free flap plays an important role in a successful result. The influence of radiotherapy on microvascular reconstruction in the head and neck region is also discussed. The authors recommend the use of fibula and scapula as donor site for reconstruction of complex (i.e. interesting also the adjacent soft tissues, muscles, mucosa and skin) mandibular defects that require more than 6 cm of bone graft length. Corticotomies of bone ensure a perfect adaptation of the graft to the mandibular form with a good aesthetic result, while the use of dental osseointegrated implants allows total masticatory functional rehabilitation. It's important that these techniques must be utilized in well organized hospital centers by experienced surgeons who are able to resolve entirely the problems and needs of the patient.