Evaluation of Changes in Bone Height And Bony Union In Free Fibula Flap for Microvascular Reconstruction of Mandible

Objective: This study was done to evaluate the changes in vascularised free fibula graft for mandible reconstruction with respect to height of fibula graft and bony union at the ends of graft and osteotomy sites. Methods: A follow up study was conduted with 5 cases of mandibular resection due to aggressive benign tumor and reconstruction with vascularised free fibula flap. Changes in bone height were measured over time using serial panorex evaluation with respect to anatomic site of reconstruction immediate after surgery, after 3 , 6, 9 and 18 months postoperatively. Measurements were taken with vernier caliper in subsequent panorex examinations. Results: Radiographic aanalysis showed bony of union of the graft ends and at the osteotonmy sites in 4 cases. One patient who had post operative infection bony union was not definite.The height of fibula for the central segment was initially 18 mm and it decreased to 14.28 percent of the initial height (mean 2.4 mm) after 12 months. The height of body part ranged from 14mm to 19 mm initially and decreased to 5.35 percent of initial height (mean 0.75 mm). For the mandibular ramal segment , the height ranged from 11mm to 12 mm initially, and it decreased to 13 percent of the initial height ( mean 1.5 mm). The analysis revealed a monthly atrophy of the fibula bone of about 0.12 mm. Conclusion : The vascularised free fibula flap is a durable method of osseous mandibular reconstruction.