Second Vascularized Fibula Flap and Osteotomy to Correct Malocclusion

For alveolar bone augmentation, a further reconstructive procedure is possible with a new revascularized fibula flap fixed onto the surface of the first fibula, placed as reconstruction of the basal bone of the mandible. Two consecutive vascularized free flaps are reported in a small series of patients affected by recurrent squamous cell carcinoma. A second fibula vascularized flap is reliable for simultaneous augmentation in symphysis, parasymphysis, and the premolar area over a previous fibula flap: implant-borne dental rehabilitation becomes practicable to improve quality of speech and diet. Malocclusion and asymmetric facial contour may follow reconstruction of the jaws with vascularized fibula flap for an inaccurate insetting procedure. The misaligned reconstructed jaw may influence the implant placement, resulting in occlusal overload that may impair the long-term survival of implant-supported prostheses. Correction of malocclusion after fibula graft may be obtained by secondary osteotomies. We described the use of a Le Fort osteotomy to correct malocclusion after fibula flap reconstruction of the maxilla. The ideal dental relationships of the osteotomized and moved jaw can be established by using a surgical acrylic splint, which is secured to the opposing dentition. The peroneal vessels can be ligated on this occasion, enabling the osteotomized jaw to move with more ease and thus proceed according to the planning.