Reconstruction of the segmental mandibular defect:  current state of the art.
OBJECTIVE
This article reviews literature pertaining to advances in the reconstruction of segmental mandibular defects in the context of an established standard of care, microvascular transfer of free osteocutaneous flaps.


RESULTS
Most literature reiterates established reconstructive techniques. Exceptions include the use of computer-assisted modeling to preoperatively design the excision of both the mandible and fibula segments and to produce a template for contouring the neomandible, the design of new flaps, distraction osteogenesis and techniques for dealing with osteonecrosis.


CONCLUSIONS
The microvascular transfer of free osteocutaneous flaps remains the standard of care, with the fibula flap the clear favorite. Review of the evolution of this flap for segmental mandibular reconstruction provides the bulk of the literature. Improvement on this standard of practice continues to be elusive, in large part because of the effects of associated radiation. Tissue engineering holds promise but no current practical application is available.
Mayo Clinic, Phoenix, Arizona, USA. Hayden.Richard@mayo.edu
Richard E
RE
Hayden
David P
DP
Mullin
Andrew K
AK
Patel
D016025:Bone Transplantation / Q000379:methods; D058752:Free Tissue Flaps / Q000098:blood supply; D008334:Mandible / Q000528:radiation effects; D008336:Mandibular Diseases / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery*; D063168:Mandibular Osteotomy; D063175:Mandibular Reconstruction / Q000379:methods*; D008866:Microsurgery / Q000379:methods; D009065:Mouth Rehabilitation / Q000379:methods; D010025:Osteoradionecrosis / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000379:methods