CBCT is a novel imaging technique appropriate for detailed and three-dimensional analysis of the condylar position in orthognathic surgery. Available freeware analysis software can be applied for metrical measurements. Our cases showed no significant changes of condylar position immediately after surgery without intraoperative condylar fixation.

BackgroundMandibular reconstruction by means of fibula transplants is the standard therapy for severe bone loss after subtotal mandibulectomy. Venous failure still represents the most common complication in free flap surgery. We present the injection of heparine into the arterial pedicle as modification of the revising both anastomoses in these cases and illustrate the application with a clinical case example.MethodsMethods consist of immediate revision surgery with clot removal, heparin perfusion by direct injection in the arterial vessel of the pedicle, subsequent high dose low-molecular weight heparin therapy, and leeches. After 6 hours postoperatively, images of early flap recovery show first sings of recovery by fading livid skin color.ResultsThe application of this technique in a patient with venous thrombosis resulted in the complete recovery of the flap 60 hours postoperatively. Other cases achieved similar success without additional lysis Therapy or revision of the arterial anastomosis.ConclusionRescue of fibular flaps is possible even in patients with massive thrombosis if surgical revision is done quickly.