Reconstruction of maxillo-facial defects creates a challenge for oral and maxillo-facial surgeons. It requires basic knowledge of anatomy and thorough skills for harvesting osseous and soft tissue to reconstruct the defective area.

Aim: To select and compare between different approaches for mandibular reconstruction.

Patients and methods: A total number of thirty patients of different age groups complaining of different mandibular lesions were selected for resection and reconstruction of their defects either simultaneously or delayed after thorough investigations. The reconstruction will depend on many factors which include size, site of the defect, age and medical status of the patient, nature of the donor and recipient site.

Results: Immediate reconstruction is preferred than delayed one if it is feasible. In children preservation of the periostium is mandatory for self bone regeneration without harvesting bone graft. Micro-vascular bone grafting is the golden standard for reconstructing large bone defects while non vascularized iliac crest bone grafting is suitable for mild to moderate bone defects.

Recommendations: Rehabilitation of the reconstructed patient is mandatory as soon as possible for preserving bone, contour and facial symmetry by inserting dental implants with bridges or over dentures.