Segmental mandibulectomy and microvascular reconstruction with fibula free flap: Comparison between intraoral and extraoral approaches

Abstract

BackgroundSegmental mandibulectomy and reconstruction of resulting defect can be performed via intraoral approach (IOA) or extraoral approach (EOA). Both approaches have advantages, disadvantages, indications, contra-indications to consider during their selection. ObjectiveTo compare IOA vs EOA of segmental mandibulectomy and microvascular reconstruction with fibula free flap (FFF). MethodsWe conducted a retrospective cohort study in which 51 patients who underwent segmental mandibulectomy and microvascular reconstruction with FFF from 2020 to 2024 were included, especially 17 patients by IOA and 34 patients by EOA, representing both groups of this study. Clinical characteristics, surgery parameters, and patients’ prognosis were evaluated. Patients’ satisfaction and DAS59 were assessed during follow-up. ResultsAmeloblastoma was the most frequent diagnosis (52.9% by IOA vs 70.6% by EOA); FFF was frequently positioned as double barrel (94.1% by IOA vs 88.2% by EOA). Compared to EOA group, IOA group had fewer intraoperative blood loss (MD = -112.2, 95% CI (-178.9 to -45.5), p = 0.001), higher satisfaction score (MD =1.3, 95% CI (0.9 to 1.7), p ˂ 0.001), and lower DAS59 score (MD = -0.5, 95% CI (-0.7 to -0.2), p ˂ 0.001). ConclusionBoth IOA and EOA were found safe and feasible, presenting similar perioperative features and postoperative outcomes. IOA patients were very satisfied with esthetic outcome than EOA patients. In absence of simultaneous immediate implant during mandibular FFF reconstruction, after stability of FFF on the defect site patients should always be referred to implantologist and/or prosthodontist for teeth restoration to improve functional and esthetic outcomes.