Sagittal Split Osteotomy of the Fibula for Modeling the New Mandibular Angle

Fibula modeling techniques for mandible reconstruction carry a high risk of bone perfusion impairment and low predictability of osteotomy angles. To restore the parabolic shape of the mandible, the number of osteotomies should be as small as possible to preserve both periosteal and endosteal perfusion. We report our approach with sagittal split osteotomy (SSO) technique for mandibular angle reconstruction. Obwegeser-Dal Pont SSO of fibula flaps was performed on 10 patients who underwent mandibular angle reconstruction. Bone segments were tilted according to stereolithographic template and fixed with 3 bicortical screws in triangular fashion. Fibula-gonial angle at 15 days and 6 months from surgery was compared with the contralateral-mandibular-gonial angle using Kruskal-Wallis test with a P < 0.05 considered significant. Mean bone length and skin paddle size were 15.6 cm (range, 13-18 cm) and 22.5 cm(2) (range, 3 x 4 cm to 11 x 5 cm). Bone unions occurred at 12 months (mean follow-up, 39 months). No differences (P > 0.05) between fibula-gonial angle at 15 days (mean, 122.88 +/- 0.55 degrees; range, 122.49-123.27 degrees) and 6 months (mean, 123.36 +/- 0.88 degrees; range, 122.73-123.99 degrees) and contralateral-mandibular-gonial angle (mean, 123.20 +/- 0.80 degrees; range, 122.62-123.77 degrees) were observed. Fibula SSO allows for new-mandible angle shaping, reducing risk of pedicle and endosteal vascular impairment. Triangular bone fixation thereby emerges as a reliable technique, enhancing functional and aesthetic long-term outcomes.