The horizontal and stepped osteotomy technique for mandibular reconstruction using fibular free flap.

The mandible is an important component of the orofacial skeleton, and resection of part of the mandible as part of head and neck oncological procedures can have dramatic impact on both function and cosmesis. In this article, we describe a new technique in the resection osteotomy and flap fixation that improves the stability and aesthetic outcome of the reconstruction. The mandibular resection is performed utilizing a horizontal osteotomy above the mandibular angle on one side and a stepped body or angle osteotomy on the other side. Our technique is unique as it allows flexibility in adjusting the chin point projection to give the best possible aesthetic outcome; it allows more bone-to-bone contact, which increases the stability; it reduces rotation; and it allows for use of miniplate fixation, facilitating future rehabilitation with implants. We have been using this technique with great success in our hospital, and we recommend its use for its improved flexibility, stability, and aesthetic outcome.