Occipitoparietal bone flap for mandibular reconstruction

Mandibular reconstruction may prove to be a difficult problem. The use of vascularized bone flaps for mandibular reconstruction has shown better results than bone grafts because they offer solid bone union together with rapid recovery of form and function. The occipital vessels, from the external carotid artery and the jugular vein up to their site of emergence in the occipital fascia, have proved easy to dissect at the neck after section of sternocleidomastoid and splenius capitis longus and brevis muscles. We were able to obtain a long pedicle to move the fascia to distant sites with or without bone. Reconstruction was achieved with a full-thickness occipitoparietal bone flap, pedicled at the occipital vessels, released up to the external carotid artery to yield a long pedicle. We used this technique in four patients (age range, 8-14 years). We used vascular cranial bone for mandibular reconstruction. The cases included three resections for benign tumors (two fibromyxoma and relapsing aneurysmal bone cyst) and one hemifacial microsomia. No complications occurred. We describe some advantages with this procedure. A larger number of cases will allow us to draw further conclusions.