Introduction: Soft tissue expansion with percutaneous distensible expanders gained popularity for reconstructive surgery in the face and neck. Purpose: The aim of this study was to compare by using tissue expander with autogenous bone graft versus autogenous bone graft only for reconstruction of anterior region of the mandible. Materials and Methods: The study included 20 patients with anterior mandibular bony defects. Patients were randomly divided into 2 groups. Patients in group I, underwent mandibular augmentation with tissue expander followed by autogenous bone graft. While in group II, autogenous bone graft was used only. Preoperative and six months postoperatively; computed tomography and lateral cephalometric views had been performed in all cases in both groups. Cephalometric points, landmarks and measurements are recoded to compare between both groups regarding pre and postoperative results. Results: In both groups, comparison between pre and post-operative variables showed; significant difference of the mandible in the anteroposterior direction and non-significant change in the vertical measurements. Soft tissue profile showed significant increase in the position of the upper and lower lip and soft tissue pogonion. While, the nasolabial angle, the pronasale, and soft tissue A point showed non-significant changes. Comparison between both groups showed significant improvement of the horizontal direction of the mandible, mandibular length and soft tissue profile in group I than group II. P-value (> 0.05) was considered non-significant. Conclusion: Tissue expansion has become a popular procedure in the reconstruction of face and neck lesions.