CHALLENGES IN THE RECONSTRUCTION OF SEGMENTAL DEFECTS OF THE MANDIBLE

Abstract

Reconstruction of segmental mandibular defects is one of the greatest challenges in maxillofacial surgery due to its anatomical and functional complexity. The microvascularized free fibular flap (FRF) is the current gold standard. This study, characterized as a narrative literature review, analyzed the most recent evidence on reconstructive challenges. The results indicate that the choice of fixation method is critical, with mini-plates (MP) demonstrating lower hardware complication rates than reconstruction bars (RB). Virtual planning and the use of 3D templates significantly improve surgical precision, reducing operative time and improving facial symmetry. The stability of the bone union and rigid fixation, more than the tissue origin (fibula-fibula versus fibula-mandible), are determinants to avoid pseudarthrosis. Alternatives such as anterior ramus grafts are valid for smaller defects in at-risk patients. Tissue engineering, inspired by intramembranous ossification, represents a promising frontier, although virtually planned free fibular flap reconstruction (FFR) remains the cornerstone of current reconstructions. It is concluded that success requires a multidimensional approach, integrating refined technique, biomechanical stability, and biological innovation, aiming for increasingly functional and aesthetic results.