BackgroundWe present our experience with transoral segmental mandibulectomy, in conjunction with vascularized osseous mandibular reconstruction, utilizing an intraoral anastomosis and free of extraoral incisions. Virtual surgical planning (VSP) and intra-operative navigation were used to help achieve this minimally invasive and scar-free approach. Additionally, we performed a cadaver dissection to highlight relevant anatomic details of the facial artery and vein. MethodsBetween January 2018 and October 2018, transoral segmental mandibulectomy followed by vascularized osseous reconstruction using an intraoral anastomosis was performed on 9 patients. Pre-operative VSP and intra-operative navigation were used in all cases. The anastomotic recipient vessels were the facial artery and vein. Postoperative panoramic radiographs and CT images were obtained for assessment of the neo-mandible. ResultsSuccessful transoral segmental mandibulectomy was achieved in 9 patients, with an intraoral anastomosis successfully achieved in 8 patients. In one patient, an extraoral anastomosis was required because of challenging facial vein anatomy. Both recipient and donor sites healed uneventfully. In all cases, a well positioned neo-mandible with good occlusion was demonstrated on postoperative imaging and exam. A symmetric facial appearance with no restrictions in mouth opening was also achieved in each case. ConclusionsTransoral segmental mandibulectomy combined with intraoral microvascular mandibular reconstruction is a surgically achievable technique with the benefit of being scar free. In our cadaver dissection, we describe the anatomical course of the facial artery and vein. An average angle of 30 degrees between these vessels is identified.