Facial CT Scans Research Articles

Myofibroblastic Sarcoma of the Maxillary Sinus: Very Rare Entity

Introduction: The Myofibroblastic Sarcoma is a recently discovered malignant tumor that mainly affects the face and neck region, but it occurs most often in the tongue and oral cavity. However, involvement of the maxillary sinus has only been reported a few times in the literature. It is a slowly growing neoplasm with a high recurrence and metastasis risk.  Case Presentation: 18 years old female patient, admitted for a painless mass of the left hemi palate increasing progressively in volume evolving since 5 months, associated to a left nasal obstruction and purulent rhinorrhea. Once in our department, she underwent a facial CT scan, followed by a facial MRI, which showed a tissue process centered primarily on the left maxillary sinus, causing lysis of the inferior wall and bulging of the hard palate on the left side . The surgical decision involved combining an endoscopic and external approach, and was supplemented by radiation therapy. The follow up demonstrated a successful outcome. the patient did not present any recurrence or distant metastasis.  Conclusion: The key lessons are the essential role of imaging in diagnosing and treating LGMS , as well as the crucial role of postoperative radiotherapy in preventing recurrence even though this subject is still controversial.

Mandibular Fracture in a Newborn From Birth Trauma: A Case Report

Objective: To report a case of mandibular fracture in a newborn presenting with post-delivery oral cavity bleeding and to discuss its etiology, clinical findings, diagnosis, management and outcome after treatment. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Results: A newborn girl was referred for oral cavity bleeding after partial breech extraction. An intraoral hematoma and symphyseal step deformity on examination corresponded to a complete fracture of the symphysis and downward displacement of the left hemimandible on facial CT scans with 3D reconstruction. An uneventful closed reduction with external fixation using acrylic cap splint with circum-mandibular wiring was performed under general anesthesia and she was discharged feeding well. The cap splint and wires were removed after 4 weeks showing good facial symmetry and bone alignment. There were no complications on follow-up after 1 year. Conclusion: Mandibular fracture can result from traumatic delivery and present with oral bleeding and hematoma. A thorough physical examination and workup should be done to assess for the sites involved. A multidisciplinary approach should be undertaken to provide the best possible care with the least invasive technique.

Does adjunctive fixation in conjunction with miniplate affect condylar position and morphology after mandibular advancement through bilateral sagittal split ramus osteotomy? A retrospective 3-dimensional CT comparative study

To minimize condylar positional and morphological changes after mandibular advancement through bilateral sagittal split ramus osteotomy (BSSRO), surgeons add either a bicortical screw or a two-hole plate distal to the conventional single miniplate. Since there have been no previous studies investigating the effect of this combination, our study aimed to evaluate the short- and long-term effects of these adjunctive fixation methods (AFM) on condylar positional and morphological changes after mandibular advancement through BSSRO.This retrospective cohort study included consecutive patients with retruded mandibles who were treated in the Department of Orthognathic and TMJ Surgery at West China Hospital of Stomatology, Sichuan University. The patients were divided into two groups based on the primary predictor variable, which was the addition of AFM — either a single bicortical screw or a two-hole plate in addition to the single miniplate. The primary outcome variable was the condylar positional and morphological changes after mandibular advancement through BSSRO. Three-dimensional facial CT scans were obtained at three different time points (preoperatively — T0, 1 week postoperatively — T1, and 1 year postoperatively — T2) and analyzed using ITK-SNAP, 3D Slicer, and SlicerSALT software. Intergroup comparisons were conducted with an independent t-test, with a p-value of <0.05 considered significant. Correlations between the variables were estimated by Pearson correlation. The study comprised 51 patients (32 females, 19 males; mean age 25.13 ± 4.24 years), involving a total of 81 condyles (21 unilateral and 60 bilateral).There was a significant difference in long-term condylar displacement in favor of AFM along with a single miniplate (p < 0.001). The bicortical screw group recorded less condylar displacement than the two-hole plate group horizontally (0.11 mm vs 0.22 mm) and sagittally (0.03 mm vs 0.17 mm), but more vertically (0.85 mm vs 0.03 mm). Bone formation associated with AFM occurred on all condylar surfaces, compared with only three surfaces in the single miniplate group.The adjunctive method in addition to the single miniplate fixation method showed less condylar displacement and more bone apposition after mandibular advancement through BSSRO. The follow-up duration variable was the only significant determinant for volumetric changes in the condyle.

Management of a Large and Strange Intraocular Foreign Body: Case Report

Introduction: Intraocular foreign bodies (IOFBs) are unusual and can cause serious eye damage. Case Presentation: We present a case report of a 62-year-old male patient who presented to our ophthalmic emergency department with an intraocular foreign body following a domestic accident.Imaging evaluation with facial CT scan confirmed the presence of a foreign body, made of glass, without any associated bone fractures. Conclusion: Previous studies have emphasized the potential complications and visual consequences associated with these injuries.This case report contributes to the existing literature on intraocular foreign bodies and reinforces the importance of prompt diagnosis and appropriate management.

Un imprevisto tra capo e collo: la sindrome di Lemierre

A healthy 15-year-old boy was hospitalized due to the persistence of lateral cervical swelling associated with fever and worsening of headache. He underwent a neck and facial mass CT scan showing a thrombophlebitis of the internal jugular vein extended to the intracranial sinuses. The diagnosis of Lemierre syndrome (LS) was formalized with positive blood colture for Fusobacterium necrophorum. Intravenous antibiotic therapy associated with anticoagulant therapy was started with complete clinical recovery after 4 weeks of treatment. A close clinical-instrumental follow-up was set up. Lemierre syndrome is a thrombophlebitis of the internal jugular vein, that in this case was extended to the intracranial sinuses. It is a rare condition, secondary to the extension of an infectious process starting from the oropharynx. The clinical picture is characterized by high fever, persistent pharyngitis followed by sepsis, pneumo-nia or atypical laterocervical pain. Fusobacterium necrophorum, a gram-negative anaerobe bacteriu,, is the responsible pathogen in most of the cases (&gt;90%). The antibiotic treatment is prolonged (at least 4-6 weeks); occasionally a parallel surgical approach is necessary. The start of anticoagulant thera-py for internal venous thrombosis associated with LS is still matter of debate.

A Rare and Challenging Entity: Sino-Nasal Nk/T-Cell Lymphoma

Extranodal NK/T-cell lymphomas are a rare subtype of non-Hodgkin’s lymphomas. They represent a diagnostic challenge due to their clinical presentation polymorphism and to the abundance of the necrotic tissues on biopsies. We report the case of a male patient that initially presented with chronic facial and palatine pain, associated to a palatine substance loss and a jugal edema on physical examination. Facial CT scan showed the lesion and its extension to the nasopharynx and association to multiple cervical lymph nodes. Initial biopsies have erred the diagnosis showing signs of a mycotic infection with no malignant cells. Considering the bad response to anti-fungal treatment, biopsies and radiological explorations were redone and were in favor of a NK/T-cell lymphoma. Locoregional and distant extensions of the disease were studied, showing an hepatic suspicious nodule and mediastinal lymph nodes. Then, the patient underwent sequential chemo and radiotherapy with a good response to treatment.

Radiographic Measurement of Nasopharyngeal Depth from the Anterior Nasal Spine (ND-ANS) Among Filipino Adults

Objective: To determine a normative value for the nasopharyngeal depth from the anterior nasal spine (ND-ANS) among normal adult Filipinos using Computed Tomography scans.&#x0D; Methods:Design: Cross-sectional studySetting: Tertiary National University HospitalParticipants: Of 516 adult patients that underwent facial, neck and temporal bone CT scans in our hospital between January 1 to June 30, 2019, 100 cases were randomized to be included in the study and 91 CT scans were analyzed.&#x0D; Results: The mean nasopharyngeal depth from the anterior nasal spine among Filipino adults is 7.17 ± 0.42. There was a significant difference between sexes with a mean measurement of 7.23 cm ± 0.44 in males and 7.09 ± 0.37 cm in females. There was no statistically significant difference in mean nasopharyngeal depth across age groups.&#x0D; Conclusion: A statistically significant difference was observed between sexes in our study sample. Our study provides initial normative values of nasopharyngeal depth among adult Filipinos, and additional studies may use this as a basis for further research.

Patient-specific plates for facial fracture surgery: A retrospective case series

ObjectivesSurgeons often encounter challenges when treating maxillofacial fractures using conventional methods that involve trimming or bending ready-made titanium plates for open reduction and internal fixation (ORIF) since it can be time-consuming, imprecise, and inconvenient. This retrospective case series aimed to introduce a novel bone reduction method that utilizes virtual planning, patient-specific surgical guides, and titanium plates. MethodsSeven patients with mandibular symphysis or subcondylar fractures resulting from facial trauma underwent cone-beam computed tomography (CBCT) or facial CT scans, and their medical histories were documented. Virtual surgery was conducted based on three-dimensional (3D) stereolithography images derived from CT scans using the FaceGide software (MegaGen, Daegu, Korea). ORIF was performed using patient-specific surgical guides and plates that were designed, printed, and milled. Radiographic, clinical, and occlusal evaluations were conducted at two weeks and six weeks postoperatively. Subsequently, 3D images from virtual surgery and postoperative CT scans were compared. ResultsThe comparison of 3D virtual surgery and postoperative images revealed minimal surface differences of less than 1 mm. T-scan evaluations indicated that there were no statistically significant differences between the two- and six-week postoperative assessments. Favorable clinical outcomes were observed. ConclusionThis novel method demonstrated stable outcomes in terms of occlusion and healing, with no notable complications. Consequently, this approach may serve as a viable alternative to conventional methods. Clinical SignificanceFacial fracture surgery that utilizes patient-specific surgical guides and plates within a digital workflow can facilitate meticulous surgical planning, reducing the risk of complications and minimizing operation time.

Fracture of the Petrous Carotid Canal

A 23-year-old male motorcyclist experienced blunt head trauma with loss of consciousness, headache and vomiting, epistaxis and right otorrhagia after a collision with a motor vehicle. Fractures involving the right parietal and temporal bones, as well as acute subdural and subarachnoid hemorrhage were identified on a cranial and facial CT scan. On independent evaluation of the imaging study, a subtle but distinct fracture line in the skull base involving the petrous carotid canal was identified. (Figure 1) The patient subsequently underwent CT angiography to evaluate for any injury to the internal carotid artery. In this examination, good opacification of the internal carotid arteries and their branches was noted, with no evident aneurysm, arteriovenous malformation or arteriovenous fistula formation.&#x0D; In patients with temporal bone fractures, the most commonly encountered complications are: tympano-ossicular injury causing conductive hearing loss, cochlear or vestibular injury causing sensorineural hearing loss or vertigo, facial nerve trauma causing facial paralysis, and fractures of the tegmen or posterior cranial fossa plate causing cerebrospinal fluid leaks.1 On the other hand, injury to the intratemporal portion of the internal carotid artery has been described as a rare complication and as such may be overlooked.1 However, its potentially devastating and life-threatening sequelae necessitates a purposeful and intentional evaluation for its presence. These sequelae include brain ischemia from arterial dissection or complete vascular occlusion, exsanguinating epistaxis or otorrhagia from carotid pseudoaneurysms, and the formation of carotid-cavernous fistulas.2 The incidence of involvement of the carotid canal in skull base fractures has been reported to be around 24%, with around 11% of this group developing internal carotid artery injuries.3 As such, the presence of fractures involving the petrous carotid canal is an indication for CT or MR angiography to further evaluate the internal carotid artery.4

Maxillary Aneurysmal Bone Cyst: About a Case

Introduction: Aneurysmal bone cyst (ABC) is a primary or secondary benign tumor, consisting of an intraosseous cavity, uni or multilocular, with hematic content. It can develop on all bones of the skeleton with, however, a predilection for the long bones and the spine. KOA mainly affects children and young adults, with a slight female predominance. Objective: The aim of this work is to reveal the diagnostic features at the imaging level. Case Report: This is an 11-year-old female patient with no previous pathological history who has presented for 1 year with diffuse maxillofacial pain, with intermittent fluid discharge in the oral cavity. Facial CT scan without and with contrast injection objective a lytic image centered on the lateral wall of the left maxillary sinus bulging into the sinus lumen with a spontaneously hypodense multicompartmental appearance without contrast gain after PDC injection. Conclusion: KAO is a very polymorphic lesion, which presents a diagnostic problem (Aspecific radiological appearance). In spite of the different therapeutic modalities proposed, it is the surgical treatment which exposes less risk of recurrence.

The Complete and Two-Turn Cochlear Duct Length Among Filipinos

&#x0D; &#x0D; &#x0D; &#x0D; ABSTRACTObjective: This study aims to measure the complete and two-turn cochlear duct lengths in a Filipino population using archived CT scan images.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Methods: &#x0D; Design: Retrospective Review of Records&#x0D; Setting:Tertiary Government Training Hospital&#x0D; Participants: CT Scan Images of 255 patients&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Cochlear images of patients who underwent cranial, facial, orbital, paranasal sinus and temporal bone CT scans from January 2019 to December 2019 were analyzed. Coronal oblique images from 3D multiplanar reconstructions were obtained and a single linear measurement (‘A’ value) was used as the spiral coefficient to calculate the complete cochlear duct length (CDL) and two- turn length (2TL).&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Results: A total of 510 cochlear images were obtained from the CT scan images of 255 subjects (143 males, 112 females aged 1 to 81 years; mean age = 47 years). The mean ‘A’ value was 8.81 mm (SD = 0.20). The mean complete cochlear duct length was 32.68 mm (31.01 mm – 35.50 mm; SD = 0.834) while the mean two-turn cochlear duct length was 29.61 mm (28.14 mm – 32.08 mm; SD = 0.732). The complete and two-turn cochlear duct lengths in males were found to be significantly longer than in females (p = .001). No significant difference was found between cochlear measurements for left and right ears.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Conclusion: The mean complete cochlear duct length among Filipinos in our study measures 32.68 mm while the mean two-turn cochlear duct length measures 29.61mm. Both complete and two-turn cochlear duct lengths were longer among Filipino males than among females.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Radiological relationship of the ethmoid slit with the frontal sinus and the anterior ethmoidal artery and applications to the frontal sinus drillout.

To compare two types of CT acquisition parameters: CT scan of the facial bone and CT scan of the sinuses, for studying the ethmoidal slit and its relationship with the frontal sinus and anterior ethmoidal artery. Retrospective study of 145 scans of the sinuses and 79 of the facial bones performed between 2012 and 2016. On each scan, the visibility of the ethmoidal slits, their length, their distance from the ethmoidal artery, and their relationship with the anterior and posterior wall of the frontal sinus were studied. The ethmoidal slit was better visualized on CT scans of the facial bone (58.2%) than on those of the sinuses (43.1%) (p = 0.02). The distance between the anterior ethmoidal artery and the anterior part of the cribriform plate was 9.3mm for CT scans of the facial bone and 8.4mm for CT scans of the sinuses. The theoretical risk of damaging the glabellar soft tissue and that of damaging the meninges during a frontal sinusotomy was evaluated, respectively, at 9.6% and 26.1% for CT scans of the facial bone, and at 6.2% and 21.5% for sinus scans. CT scans of the facial bone are better than CT scans of the sinuses for identifying ethmoidal slits and their distance from the canal of the anterior ethmoidal artery. The identification of these elements is relevant for the surgeon during frontal sinus surgery and makes it possible to assess the risk of damaging the glabellar soft tissue or meninges. Performing a CT scan of the facial bone seems preferable to that of a CT scan of the sinuses in certain pathological situations, such as cerebrospinal rhinorrhea or revision surgeries of the frontal sinus.

Giant Maxillary Sinus Mucocele: A Case Report

Maxillary sinus mucocele is a benign cyst formation that originates within the sinus and is lined by epithelium containing mucus. It’s a rare pathology characterized by a clinical polymorphism. This study reports the case of a giant left maxillary sinus mucocele in a 61-year-old female patient. Through clinical examination, vestibular deformation from tooth 23 to tooth 26 was determined, and also an exophthalmos. Facial CT scan showed a cystic mass of the left maxillary sinus with bone thinning. The treatment consisted in the excision of the mucocele pocket through Caldwell-Luc approach under general anesthesia.

Medical Image Three-Dimensional Simulation Technology in Hospital Clinical Practice

We performed three-dimensional reconstruction of facial CT scan images of patients with mandibular angle hypertrophy to explore the related factors of mandibular angle hypertrophy. At the same time, the article uses the results of three-dimensional reconstruction to simulate the clinical operation and obtain the final operation method. It was found that all patients were able to obtain the proper surgical plan from the three-dimensional reconstructed images and can get the hypertrophy factor of the mandibular angle. For this reason, we conclude that computer reconstruction simulation technology can obtain the tissue changes before and after osteotomy of mandibular angle hypertrophy and get the cause of hypertrophy. Three-dimensional reconstruction simulation technology is the best auxiliary diagnosis plan for the selection of mandibular angle surgery.

Clinical, Radiological and Histopathological Features of Patients With Lacrimal Gland Enlargement.

The purpose of this study was to describe the radiologic and histopathologic features of lacrimal gland in patients presenting with lacrimal gland enlargement. We retrospectively retrieved the data of patients with lacrimal gland enlargement in Farabi Eye Hospital between 2012 and 2017. These data included demographics, the patients' facial photographs, orbital CT-scans, and histopathological findings of lacrimal gland biopsies. Forty-seven patients (15 men and 32 women) were enrolled in this study with a median age of 37.9 years (range, 15-79 years). Histopathologic diagnoses were chronic dacryoadenitis in 26 cases (55.32%), IgG4-related disease in 6 patients (12.77%), two cases of acute dacryoadenitis, two cases of non-necrotizing granulomatous inflammation, two cases of Non-Hodgkin's B-cell lymphoma, two cases of adenoid cystic carcinoma and two cases of mixed tumor (4.26% each), as well as one case of conjunctival epithelial cyst, and one case of benign lymphoid tissue and fibrofatty tissue (2.13%). In two samples (4.26%), biopsy revealed normal lacrimal glands. Interestingly, in two cases with relapsing lacrimal gland enlargement, different histopathologic diagnoses were found in biopsies taken from each lacrimal gland at different times. The average size of enlarged lacrimal glands was 19.67 mm × 7.06 mm on axial CT scan and 19.44 mm × 6.20 mm on coronal CT scan. Tissue biopsy is needed for diagnosis of lacrimal gland enlargement because it is difficult to distinguish the type of the lacrimal gland pathology based solely on clinical or radiological presentation.

Neglected Nasal Foreign body discovered by Nasal Deformity: A Case Report and Review of the Literature

Foreign bodies of the nose are mostly common in paediatric population. In teenagers and adults, they are predominately seen in patients with mental disturbances. Usually with acute presentation, they also can remain in place for a long time. The main clinical presentation is unilateral purulent rhinorrhea possibly associated, in chronic cases, to nasal deformities, nasomaxillary abnormalities or rhinolithes. The removal can require a surgical procedure under general anaesthesia specifically in front of neglected foreign bodies covered by mucosa or previous multiple failed attempts. We report the case of a 14-years-old girl, with mental retardation, who consulted in our structure for a swelling in the left nasal alar base evolving progressively since 4 months, with intermittent purulent rhinorrhea not improved after medical treatment. No incident of nasal foreign body insertion was reported or witnessed by the patient and its family. The facial CT scan confirmed the diagnosis and the removal required surgical procedure. The diagnosis of neglected nasal foreign body should always be considered in front of unilateral nasal obstruction and discharge specifically in children and mentally disabled patients. Its removal should be rapid in order to avoid the constitution of rhinolithes and nasal deformities.

Costs of CT Scan and Ultrasound Services Using the Activity-Based Costing Method

Background: The activity-based costing system allows organizations to estimate the exact cost of their services based on the consumed resources, which in turn translates into increased efficiency of healthcare organizations.&#x0D; Objectives: The current study aimed to estimate the cost of ultrasound and CT scan services using the activity-based costing (ABC) method.&#x0D; Methods: Following a descriptive-applied design, the total cost of the most commonly used ultrasound and CT scan services in Imam Khomeini Hospital of Ahvaz was calculated using the ABC method. Data were collected using special forms and a list of services’ costs. To estimate the costs for different hospital sectors, first, the principles of determining cost proportion per service were set, and then using the direct cost approach, costs were estimated.&#x0D; Results: The highest and lowest differences from government-approved medical tariffs were related to the facial (523,000 Rials) and lung (133,000 Rials) CT scans, respectively. Also, except for abdominal and pelvic CT scans, the estimated cost of services was higher than the tariffs. The highest and lowest share of costs were related to the depreciation of capital equipment (1,174,490,000 Rials) and energy consumed by activity centers (952,000 Rials), respectively.&#x0D; Conclusions: For most of the investigated services, the total cost was significantly higher than the approved tariffs. To make medical tariffs more realistic and to continuously improve the provision of healthcare services, it is necessary to use costing techniques like ABC.

A Nasal Localization of Abrikossof Tumor Observed to Yaounde Reference Hospital

Background/Aim: Abrikossof’s tumor or granular cell tumor is a rare tumor. The cervicofacial localization is the most common. The aim of this report case was to show a rare case of nasal localization, to the 48-year old patient, treated in poor medical condition. Case presentation: The patient consults late with enormous nasal mass involving for five years. After biopsy and facial CT-scan, a surgical procedure was performed. The evolution was good and the final pathology confirms the diagnosis. The objective of this case report was to show the originality of the presentation and the difficulties for management in poor medical environment. Conclusion: Abrikossof’s tumor is a rare benign tumor but whose preferential development occurs at the expense of the ENT sphere. Large forms remain the preserve of poor environments. The diagnosis is pathological and the treatment is surgical.

Endoscopic Endonasal Surgery at the Yaounde General Hospital-Cameroon: Case Study of 30 Operated Patients

Introduction: Endoscopic endonasal surgery is currently a validated therapeutic modality in most nasal sinus disorders. In developed countries, this practice is common and sees the indications constantly reviewed; In sub-Saharan Africa, this surgical technique is popularized. The external pathways are morbid and not very functional. In our daily practice at the Yaounde General Hospital (YGH), this technique is still in its infancy. Gradually it’s entering our habits and sees its indications increases. Through this study, we are reporting readily available data from our experience. Objectives: The objective was to study the practice of endoscopic endonasal surgery in our setting. Patients and Method: This was a cross-sectional, descriptive, retrospective study. The site of study was the ear-nose and throat service of Yaounde General Hospital. The study was conducted from January 2013 to December 2020, for an 8 years basis. The sampling was consecutive. We included in this study all patients operated on for a nasal sinus disease by the endoscopic endonasal modality. We excluded patients with incomplete files, as well as those who had a complementary transfacial approach during the same operation. The data were collected on prepared questionnaire. Data analysis is done with ssps 23.0 software. Results: We recruited 30 cases, out of a total of 330 interventions carried out in our department. The prevalence of this surgery in our activity was 9%. Male and female had equal ratio of 50%. The most represented age group was 30 - 40 years (33.3%). All the patients had a facial sinus CT scan, we did not note any anatomical variant as risk. Two patients of our sample size had a history of sinus surgery, treated externally. Chronic maxillary sinusitis was the surgical indication in 36.7%, followed by Killian antro-choanal polyps in 13.3%, nasosinus polyposis in 13.3% and all performed under general anesthesia. The most performed procedure was unilateral mean meatotomy with 43.33% followed by bilateral mean meatotomy with 20%, ethmoidectomy 13.3%, bimeatotomy 10%. The admission lasted for 2 days. 100% of patients had a previous nasal tamponade at the end of the intervention. The tamponade was removed on the second postoperative day in 100% of patients. 16.7% of patients presented with complications of low abundance postoperative bleeding. All patients noted clinical improvement over the initial symptoms postoperatively. Conclusion: Endoscopic endonasal surgery is experiencing slow but certain progress in our daily practice. The operated patients are young, chronic maxillary sinusitis is the main indication, the most performed procedure is the unilateral mean meatotomy. The operation goes uneventful with satisfactory prognosis. A study with a larger sample is necessary in order to refine our results. The practice remains limited by the technical platform, which needs to be strengthened, in order to optimize the practice.

Malocclusion Management Following Mandibular Reconstruction With Free Fibula Flaps.

Free fibula flaps are nowadays the gold standard for the surgical reconstruction on large mandibular defects. Malocclusion is an important complication of this type of reconstruction and many of these patients end up requiring subsequent orthognathic corrective surgery. This is a descriptive retrospective case series study. To describe the demographic data, operative techniques, corrective methods and postoperative results in the management of malocclusion following mandibular reconstruction with free fibula flap. This case series study included patients who underwent free fibula flap mandibular reconstructions and who that subsequently developed malocclusion requiring orthognathic corrective surgery, from June 2010 to December 2019. Panoramic X-rays, cephalometries and/or 3-D facial reconstruction CT scans were used for surgical planning to create surgical cutting guides, templates and occlusal splints in all the patients that underwent corrective orthognathic surgery. There were 46 patients who underwent a free fibula flap mandibular and maxillary reconstruction at San Jose Hospital between June 2010 and December 2019 of these, 5 patients (10.9%) developed postoperative malocclusion. One case from another institution was added to this study for a total of 6 patients with malocclusion following mandibular reconstruction surgery with a fibula free flap. During the orthognathic surgery, vertical osteotomies were performed in 3 patients and bilateral sagittal split osteotomies were necessary in 2 patients and L-shape in 1 patient. Osteogenic distraction was performed in 3 patients as part of their orthognathic treatment. The fixation methods were based in miniplates for 3 of the patients and lag screws for the remaining 3 patients. With this approach, all patients had an adequate occlusion correction with a 100% consolidation at their 6-month follow up. Malocclusion is a significant complication following mandibular reconstruction surgery that must be identified and managed. In severe cases, it requires corrective orthognathic surgery in severe cases. We have developed a protocol to avoid pitfalls during the primary reconstruction and in case an orthognathic surgery is required for malocclusion correction, preoperative planning with cutting guides and occlusal splints should be assessed, to guarantee favorable results through a reproducible technique.