Intraoral versus transcervical approaches in mandibular reconstruction with free flaps: A retrospective study

The fibula free flap has become the workhorse for mandibular reconstruction since it was first introduced by Hidalgo in the year of 1989 (Hidalgo 1989). In the past decades, significant advances in computer-assisted technology, such as computer-assisted design and manufacture (CAD/CAM), three-dimensional (3D) printing, virtual surgical planning (VSP) and prefabricated cutting guides, have greatly improved the contour and positioning accuracy of fibular-based mandibular reconstruction (Avraham et al., 2014; Ince et al., 2020; Tepper et al., 2012; Seruya et al., 2013). Compared with traditional freehand mandibular reconstruction, computer-assisted technology reduced ischemic and reconstructive time of fibular-based reconstruction as well as patient's length of hospital stay (Ince et al., 2020). More importantly, it enables decreased invasive or concealed approaches to segmental mandibular reconstruction, especially when the primary lesion is a benign or low-grade malignant tumor (Nkenke et al., 2013).

Transcervical approach is commonly used for segmental mandibular reconstruction because of its excellent surgical exposure for mandible resection, free flap positioning and vascular anastomosis (Landa et al., 2003). With the trend towards scarless, intraoral approach is recommended for a better aesthetic appearance with the help of VSP and prefabricated cutting guides (Lim et al., 2020; Nkenke et al., 2013; Sun et al., 2022). However, expended segmental mandibulectomy with intraoral microvascular reconstruction is clinical challenging even for well-trained and experienced surgeons (Sun et al., 2022). Although these two approaches are effective in acquiring a symmetrical contour of reconstructed mandible, clinical variables including operation time, blood loss and postoperative complications as well as functional outcomes, have not been described in the current literature. Moreover, aesthetic evaluation of patient-reported assessment, which appears to be the main advantage of intraoral approach over transcervical approach, has not been demonstrated yet.

The aim of this study was to investigate the clinical and functional differences between intraoral and transcervical approaches for segmental mandible resection and reconstruction with free flaps.

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