The aim of this review was to provide an update on survival rates of osseointegrated implants into common composite free flaps used for maxillary and mandibular reconstructions and identify factors affecting outcomes. PubMed, Medline, Embase, and Cochrane databases were searched. Included studies reported implant survival by flap type. Results were pooled and survival was estimated with the Kaplan‐Meier method. Variables affecting survival were assessed using Cox regression. Thirty‐two of the 2631 articles retrieved were included, totaling 2626 implants placed into fibula, iliac crest, scapula, and radial forearm free flaps. Pooled survival showed 94% 5‐year survival of implants in fibula and iliac crest with no difference between groups (P = .3). Factors effecting survival included radiotherapy (HR 2.3, 95% CI 1.2‐4.6, P = .027) and malignant disease (HR 2.2, 95%CI 1.6‐3.1, P < .001). Implant survival appears adequate across common flap types; however, there are limited numbers reported in less common flaps.

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The surgical treatment of cancer involving the maxillofacial region results in significant morbidity and reduces the health-related quality of life of patients (Barrios et al., 2015;Kamstra et al., 2011). The development of surgical techniques in recent decades has resulted in the use of composite free flaps as the ideal choice for reconstruction of large segments of the maxilla and mandible (Batstone, 2018).Composite free flaps restore facial structure, improve airway function, speech, deglutition, mastication and create a foundation for

Mucopolysaccharidoses are a group of rare lysosomal storage diseases caused by a deficiency of enzymes, which breakdown glycosaminoglycans, with consequent dysfunction of affected tissues. Mandibular coronoid hyperplasia, with associated trismus, has been recently described as a feature of the craniofacial abnormalities seen in these patients. However, the details of the surgical and post-operative management of these patients have not been previously documented. This case describes the successful management of severe trismus from coronoid process hyperplasia in a 14-year-old male, utilising an extra-oral approach for bilateral coronoidectomies and removal of exophytic zygomatic bone, followed by immediate and long-term physiotherapy. An improvement of mandibular opening from 8 to 45 mm has been maintained at 18 months post operation.

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