Sandwich osteotomy for 18 patients with insufficient fibular height after mandibular reconstruction using vascularized single-barrel free fibular flap: a retrospective study.

The insufficient fibular height after mandibular reconstruction using vascularized single-barrel free fibular flap is a Gordian knot for implantation. Numerous studies have demonstrated that sandwich osteotomy is an effective technique for bone augmentation,so it is worth investigating whether it can achieve the same result used for transplanted fibula.A total of 18 patients were retrospectively enrolled. All patients underwent single-barrel free fibula flap repair for segmental mandibular defects but the fibular height was not sufficient for subsequent implantation, so sandwich osteotomy was used to increase the height of the fibula. Cone beam computed tomography was performed prior to and 1 day, 3 months, 6 months after sandwich osteotomy. Mimics 21.0 software was used to measure the bone height obtained.The mean vertical bone augmentation was 5.15 ± 0.4 mm (range, 3.3-6.92 mm) on the 1st day post-operation and gradually decreased, eventually stabilized about 6 months post-op.All patients received implants 6-8 months post-op. The implants achieved clinical osseointegration approximately 3 months after placement, and all patients successfully completed the subsequent crown restoration. In this study, the bone augmentation of the fibula and subsequent implant restoration were both successful. We believe that sandwich osteotomy is a convenient, safe and effective technique for fibular augmentation.