[Intraoral approach combined with submandibular minor incision for mandibular defect reconstruction using vascularized iliac bone-muscle flap: a clinical study].

Objective: To investigate the clinical efficacy of intraoral approach combined with submandibular minor-incision for simultaneous mandibular resection and precise reconstruction using vascularized iliac bone-muscle flap in patients with benign mandibular lesions. Methods: From January 2023 to January 2026, 19 patients with benign mandibular lesions were enrolled. The cohort comprised 8 males and 11 females, aged 15 to 75 years (mean 46.5 years). Pathological diagnoses included ameloblastoma (n=13), recurrent odontogenic keratocyst (n=2), sclerosing osteomyelitis of the jaw (n=2), giant cell lesion (n=1), and recurrent ossifying fibroma (n=1). All procedures employed an intraoral approach combined with a submandibular minor-incision. Preoperatively, spiral CT scans of the mandible and iliac bone were utilized to construct a mandibular model, and a reconstruction titanium plate was pre-bent using computer-aided design/computer-aided manufacturing (CAD/CAM) technology. All 19 patients underwent unilateral segmental mandibulectomy with in-situ fixation of the pre-bent reconstruction plate, followed by mandibular defect reconstruction using a vascularized iliac bone-muscle flap. Immediate implant placement was performed in 12 cases. Results: Vascularized iliac bone-muscle flaps survived in 18 patients (success rate 95%), while 1 flap failed due to necrosis. All incisions healed primarily. Twelve patients underwent simultaneous implant placement. During the 1-year follow-up, all patients demonstrated satisfactory functional recovery without facial nerve injury. The occlusal relationship of the remaining dentition was basically maintained at the preoperative level. Masticatory function was satisfactory. Mouth opening ranged from 31 to 36 mm. Swallowing and speech functions were normal. Only minor scars (mean length 1.5 cm) were observed extraorally, and patients were satisfied with their facial appearance. The mean initial implant stability quotient value in the 12 implanted patients was (72.5±6.3). CBCT evaluation at 6 months postoperatively revealed an osseointegration rate of 100%. No recurrence was observed up to the last follow-up. Conclusions: Intraoral approach combined with submandibular minor-incision for simultaneous mandibular resection and vascularized iliac bone-muscle flap reconstruction, as preliminarily demonstrated in this small-sample cohort, can shorten operative time, enhance reconstructive precision, reduce maxillofacial scarring, and significantly improve patient satisfaction. It represents a reliable surgical strategy for precise simultaneous mandibular resection and reconstruction.