Mandible Reconstruction With Free Fibula Flap And Its Effect On Temporomandibular Joint Function

Reconstruction of mandibular defects represents a challenge to the plastic surgeon and maxillofacial surgeon. The fibula is the workhorse of modern-day mandibular reconstruction because of its versatility. Condyle reconstruction presents a difficult management issue in free fibula flap mandible reconstruction of the superior mandibular ramus disease. In this study, 41 cases of benign mandible and condyle defect were reconstructed with fibula free flap using three methods: (1) placement of the distal end of the fibula flap into the glenoid fossa substituted condyle, (2) attachment of the resected condyle as a nonvascularized transplant to the end of the fibula flap, (3)condyle preservation, and vascularized fibular reconstruction. The postoperation clinical result, radiological findings, temporomandibular joint function, mastication function and donor site morbidity were evaluated objectively; and preliminary using of CTA and CAD\CAM technique in free fibula flap was reported. The major contents were summarized as follows:1. Using different condyle managements in mandible reconstruction with free fibula flap is feasible and reliable. There are no severe complications happened.2. Through post-operation images of three dimensional computerized tomography and pantomography, we found there were some degrees of shape modification in new reconstruction condyle with fibula flap distal end. There was a relation between patients' age and condyle modification. The younger, the better modification. There is resorption of nonvascularized transplant condyle. There is a high rate (62.1%) of reconstruction condyle dislocation in glenoid fossa in our group, which needs taking into account in aftertime clinical practice.