Proximal Redundant Fibula Bone Template for Flap Osteotomies in Mandibular Reconstruction: A Novel Technique

Background Free fibula flap has been the workhouse of reconstruction for segmental mandibular defects. The use of computer aided design helps in achieving the desired aesthetic and functional outcome. It has its advantages but it comes with an extensive financial burden. Purpose We propose the use of redundant proximal fibula bone segment as a template and a cutting guide for flap osteotomies in mandibular reconstruction. Methods We have used this surgical technique in a case of T4 oral cancer that required segmental mandibulectomy. Result Average ischaemia time was 1 hour and 30 minutes. Based on histopathology report, both the patients required adjuvant radiotherapy. Oral competence was maintained in both the patients. Post-operatively, the contour and the orientation of the mandibular reconstruction were comparable both clinically and radiologically to the previously planned 3D cases. Conclusion This surgical technique provides an accurate guide for end angle osteotomy. In addition, it does not require any extra surgical step and does not increase the ischemia time of the flap with no additional extra cost.