An intraoral anastomosing technique for microvascular bone flaps in alveolar ridge reconstruction: First clinical results

The main indication for microvascular reconstruction of the face is to achieve the best possible functional and aesthetic outcome. In several cases of reconstruction of the alveolar ridges of the mandible or maxilla, extraoral scars might have been avoided if microvascular anastomoses had been performed without using the extraoral approach. In 9 patients with severe defects of the alveolar ridge of the mandible or maxilla caused by trauma, tumour resection, atrophy or partial loss of premaxilla, reconstruction was performed using six microvascular corticocancellous femur flaps, two iliac crest flaps and one osteoperiosteal fibula flap. In every case, an intraoral approach was used to prepare the transplant bed and the facial vessels. The anastomoses were carried out via this intraoral approach between the donor vessels and the facial vessels. The patients were followed up radiologically and clinically for 6–24 months postoperatively. There was no flap loss or severe complication postoperatively. All patients had good functional and aesthetic results, were treated successfully with dental implants 4–6 months after microvascular reconstruction, and were subsequently fitted with implant-retained prostheses. Intraoral anastomosing of microvascular bone flaps is a reliable technique for microvascular reconstruction of the alveolar ridge. Extraoral scars can be avoided.