Vertical increase in mandibular reconstructive surgery with fibula flap : double barrel and osteogenetic distraction

Aim. The free fibula flap is today considered the gold standard for mandibular reconstructions, and provides an adequate length of bone of the correct consistency for this procedure. The disadvantage is the lack of thickness, which does not offer an adequate vertical dimension for the newly constructed mandible, in particular when the procedure must be followed by osseointegrated tooth implants. Two methods have been developed to increase the vertical dimension of the new mandible: the double-barrel method and osteogenetic distraction. Methods. Between April 1995 and October 2003 at the Division of Maxillofacial Surgery, San Paulo Hospital, Milan, 63 fibula free flaps were positioned; 17 were at the maxilla and 46 at the mandible. Results. Among the mandibular reconstructions, in 4 cases the double-barrel technique was applied, with the intent of optimising the vertical dimension of the reconstructed mandible. In 2 cases in which the double-barrel technique could not be applied, osteogenetic distraction was performed on the new mandible in order to achieve a vertical increase in the various bone sectors. Conclusion. Application of these techniques made it possible to achieve adequate bone thickness in the new mandible, so as to optimise future prosthetic rehabilitation of the tooth arch.