Mandible and Temporomandibular Joint Reconstruction with Flow-through Fibula and Lateral Femoral Condyle Flaps: A Case Series

Simultaneous anatomical reconstruction of mandible and temporomandibular joint (TMJ) defects following tumor resection poses a significant challenge in achieving good healing and long-lasting functional outcomes. The authors propose a novel autologous technique using a flow-through fibula and lateral femoral condyle osteochondral flap for simultaneous mandible and TMJ reconstruction. Both flaps were harvested from the same donor leg and joined via on-table osteosynthesis and a flow-through microvascular anastomosis. Preoperative virtual planning and patient-specific cutting guides were used to optimize accuracy. This technique was applied to 4 patients with mandible tumors who underwent resection of the mandible body, ramus, condyle, and adjacent soft tissue. All patients recovered well, with functional mouth opening exceeding 3 cm and no signs of ankylosis during follow-ups. This alternative "like-for-like" autologous reconstruction method is a novel technique for large mandible and TMJ defect reconstructions, offering a durable and effective solution that enhances patient outcomes.