Introduction: Reconstructive surgery in the maxillofacial complex has experienced a great progress especially due to the introduction and refinement of procedures involving microvascularized tissue transfer to address reconstruction of primary bone defects. Microvascularized flaps maintain a vascular supply and have been demonstrated to result in fewer postoperative complications when compared to non-vascularized grafts. Agressive treatment of odontogenic tumors often wind up creating complex mandibular defects that severely impact the patient’s quality of life. The free fibular flap is a versatile and reliable option for microsurgical reconstruction of large mandibular defects, as it provides an adequate quantity of bone that can be shaped for adaptation to the remaining mandible. Also, its height allows for posterior rehabilitation with implant-based prostheses.

Case report: In this work, we present our experience with immediate mandibular reconstruction with the vascularized free fibular flap following ressection of benign odontogenic tumors (3 patients, 2 with diagnosis of ameloblastoma and 1 with diagnosis of mixoma). In two of these cases, discopexy was performed concomitantly with the grafting procedure in an attempt to maintain temporomandibular joint function on the affected side. Surgical planning, perioperative management and complications are discussed with the pertinent literature background.

Conflict of interest: None declared.