Reconstruction of bilateral extensive composite mandibular defects after osteoradionecrosis with two fibular osteoseptocutaneous free flaps

Osteoradionecrosis of the mandible is a formidable complication after radiation therapy of the head and neck area because it often leads to severe deformity that affects both function and appearance. In this article, we report a case of extensive osteoradionecrosis of the mandible associated with bilateral through-and-through cheek defects reconstructed in two stages, using two separate reconstruction plates and two fibular osteoseptocutaneous free flaps to preserve the healthy symphysis and gingival sulcus between defects. The fibular osteoseptocutaneous free flap is an ideal option for one-stage total reconstruction of complex, composite mandibular defects. A two-stage approach is a reliable reconstructive strategy in difficult cases that involve two separate lesions on both cheeks.