Mandibular reconstruction with the free vascularized fibular flap: Utilityof three-dimensional computerized tomography

Oncologic management in the mandibular area leaves important osseous defect s, that require reconstructive procedures with vascularized osseous tissues . Mandibular reconstructions with free vascularized fibular flaps have well -defined indications and some advantages over various other types of vascul arized osseous grafts, because the fibular graft permits the reconstruction of large mandibular defects. This study demonstrates the usefulness of thr ee-dimensional (3D) tomography as a tool to determine the size of the defec t, and with angiotomography, to define the anatomic pattern of the vascular pedicle. Five patients with varying mandibular tumors and osseous defects were evaluated with 3D tomography in the pre- and postoperative periods. Tw o patients were immediately reconstructed with vascularized fibular flaps. 3D preoperative tomography showed the dimensions of the tumor, the dimensio ns of the mandibular resection, and the graft vascular pattern. Three patie nts were secondarily reconstructed, two of them with partial mandibular def ects, and one patient with total mandibular reconstruction. In the preopera tive period, 3D tomography was used to determine the dimensions of the mand ibular defect, as well as the area of the osteotomies. The technology permi ts an exact knowledge of the dimension of mandibular defects, allowing bett er planning of reconstructive procedures.