Introduction of a New Mandibular Reconstruction Procedure Using a Sagittal Split: A Case Report

Soft tissue excision and segmental mandibular resection for the treatment of benign or malignant oral tumors result in surgical defects of varying extents. These procedures are often followed by adjuvant chemotherapy and radiotherapy, which induce further adverse events with limited available treatment options. To reduce the morbidity and enhance the success rate of mandibular reconstruction, we developed a novel technique that combines a sagittal mandibular split and the use of a vascularized forearm flap graft. Here, we describe our experience with this procedure in an older male patient. The bridging bone segment was pedicled using the mylohyoid muscle and periosteum, and a reliable vascularized forearm graft was used to repair the soft tissue defect. The patient experienced a rapid recovery, and a two-year follow-up revealed that the bone and skin grafts tolerated radiotherapy well. We conclude that this technique is a viable alternative for patients with a bony gap around 4 cm or in whom a vascularized fibular flap graft is contraindicated.