Mandibular reconstruction using the double barrel fibular graft

Area of Science:

• Oral and Maxillofacial Surgery
• Reconstructive Surgery

Background:

• Mandibular reconstruction presents challenges, particularly in achieving adequate bone thickness and alveolar height for functional restoration.
• Conventional fibular grafts may have limitations in bone circumference, potentially complicating denture or implant placement, especially in certain ethnic groups.

Purpose of the Study:

• To evaluate the efficacy of the double barrel fibular graft technique for major mandibular reconstruction.
• To assess the technique's ability to overcome the limitations of single fibular grafts regarding bone thickness and alveolar ridge height.

Main Methods:

• Five patients underwent mandibular reconstruction using a double barrel fibular graft between 1989 and 1994 for bony defects ranging from 7 to 14 cm.
• The fibular graft was osteotomized, folded into two parallel segments, and fixed along the inferior border and alveolar ridge of the mandible.
• Composite reconstruction with skin flaps was performed in three patients.

Main Results:

• The double barrel fibular graft achieved over 4 cm of alveolar height without compromising bone viability.
• All patients demonstrated good mandibular contour and sufficient alveolar ridge thickness.
• Patients were able to wear conventional dentures and consume a solid diet post-reconstruction.

Conclusions:

• The double barrel fibular graft technique provides increased bone thickness and alveolar height, superior to single fibular struts.
• This method offers advantages over iliac bone grafts for major mandibular reconstruction due to length, 3D reconstruction potential, and minimal donor-site morbidity.