In this video, Henry C. Vasconez MD, plans the harvest of a fibula osteocutaneous free flap to perform mandible reconstruction on a 21-year-old male with severe craniofacial microsomia and other congenital anomalies. In addition, the patient will also undergo a sagittal split mandibular osteotomy on the contralateral side, as well as a rotational LeFort 1 maxillary advancement in order to obtain improved symmetry and occlusion. As a child the patient had additional craniofacial abnormalities including craniosynostosis which was addressed surgically.
He initially underwent a costochondral bone graft to rebuild the deficient mandible in early childhood, which achieved a reasonable result during his early growth, but as he reached maturity it became grossly insufficient. The patient presented with a significant cross bite and open bite deformity as well a major skeletal and soft tissue deficiency of the entire right side of his face. In order to address this complex deformity, a combined surgical plan with oral surgery was devised utilizing computer-derived surgical modeling and the use of highly technical and precise virtual surgery. Highly precise computer-derived models of the craniofacial deformity were obtained; models were also obtained of the skeletal parts after osteotomies. A fibular free flap reconstruction was proposed for mandible reconstruction and a customized osteotomy jig was constructed for precise bone cuts and a tailor-made reconstruction plate was also obtained. The resulting vascularized bone graft was implanted in the hemi-mandibular space in order to match the upper jaw occlusion and thereby provide a more functional and better appearing facial contour.
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