Anatomical considerations of the Thai fibula used as a fibula osteocutaneous free flap in mandibular reconstruction and dental implant placement.

Objective: Although the fibula osteocutaneous free flap has many proven advantages in restoring mandibular defects, the dimension of available fibula is one of its limitations. The present study aimed to investigate the suitability of dimensions and the quality of harvested fibulae for mandibular reconstruction and dental implant placement in Thais.

Material And Method: One hundred fourteen fibulae of 57 adult Thai cadavers were dissected. Total fibular length and the length of harvested fibula were measured. Dimensions of the fibula cross sections available for dental implant placement were recorded. Additionally, the cortical bone thickness and densities of cortical and spongy bones of 60 fibulae were assayed using cone beam computed tomography scan images.

Results: Mean total fibular length and mean length of harvested fibulae were 34.2 +/- 2.3 cm and 18.2 +/- 2.3 cm, respectively. A dental implant length of 7 to 10 mm could be placed in the fibula. The mean cortical bone thickness was 2.2 +/- 0.6 mm. The mean densities of the cortical and spongy bones were 614.4 +/- 148.8 HU and -600.6 +/- 228.7 HU, respectively.

Conclusion: The present study suggests that, in Thais, a harvested fibula of 16 to 20 cm in length is sufficient to provide bone for reconstructing defected mandible and the dental implant placement is 7 to 10 mm in length. The mean cortical and spongy bone densities of fibula are less than that of the mandible in previous reports. The result supports the clinical experience using the fibula as donor site for the mandibular reconstruction and dental implant placement.