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Review
. 2021 Jan 5:62:37-42.
doi: 10.1016/j.amsu.2020.12.049. eCollection 2021 Feb.

Extended and unusual indications in jaw reconstruction with the fibula flap: An overview based on our 30-year experience

Giorgio De Santis  1 , Massimo Pinelli  1 , Marta Starnoni  1
Affiliations
Review

Extended and unusual indications in jaw reconstruction with the fibula flap: An overview based on our 30-year experience

Giorgio De Santis et al. Ann Med Surg (Lond). .

Abstract

Since the introduction of fibula flap as a reconstructive technique, an evolution of indications has been observed. Our first report of a traumatic mandibular reconstruction using fibula flap was in 1992. The vast majority of indications for surgery, are: malignant tumors, benign neoplasms, osteoradionecrosis and traumas. Nevertheless, extended indications have been described such as the treatment of dentoalveolar defect without bone discontinuity or reconstruction of maxilla defect up to type III (A and B), according to Cordeiro's classification. Unusual indications include cleft palate malformations with bone discontinuity less than 6 cm. Moreover, a particular attention should be focus on fibula flap harvest with more innovative technologies than traditional use of monopolar or bipolar and their advantages in pre and postoperative management.

Keywords: CAD/CAM; Fibula flap; Harmonic scalpel shears; Head and neck reconstruction; J-plasm; Jaw reconstruction; Mandible reconstruction; Maxillary atrophy; Orbital reconstruction; Palate cleft; Piezosurgery.

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Figures

Fig. 1a
Fig. 1a
Right minor salivary gland carcinoma: CT finding.
Fig. 1b
Fig. 1b
A resection of the right maxilla, the alveolar process, the nasal fossa, the pterygoid process of the sphenoid, the floor and the medial and lateral sides of the orbit was performed.
Fig. 1c
Fig. 1c
CT finding. The reconstruction included the use of a fibula free flap U-shaped (three bony segments U shaped) and the reconstruction of orbital walls and floor with titanium mesh and bone graft. Rectus abdominis muscle was used to fill the residual maxilla.
Fig. 1d
Fig. 1d
After radiotherapy the patient developed a moderate lower eyelid ectropion.
Fig. 2a
Fig. 2a
A 16 years-old man affected by cleft lip and palate.
Fig. 2b
Fig. 2b
Pre-operative Intraoral view.
Fig. 2c
Fig. 2c
Fibula flap harvest. Note the long pedicle and the peg-type modelling.
Fig. 2d
Fig. 2d
Implants after 6 months.
Fig. 2e
Fig. 2e
Post-operative intraoral view after definitive dentures.
See this image and copyright information in PMC

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