Abstract：
BACKGROUND: Segmental mandibulectomy and reconstruction of resulting defect can be performed via intraoral approach (IOA) or extraoral approach (EOA). Both approaches have advantages, disadvantages, indications, and contraindications to consider during their selection.
OBJECTIVE: To compare IOA vs EOA of segmental mandibulectomy and microvascular reconstruction with fibula free flap (FFF).
METHODS: We conducted a retrospective cohort study in which 51 patients who underwent segmental mandibulectomy and microvascular reconstruction with FFF from 2020 to 2024 were included, especially 17 patients by IOA and 34 patients by EOA, representing both groups of this study. Clinical characteristics, surgery parameters, and patients\' prognosis were evaluated. Patients\' satisfaction and Derriford Appearance Scale (DAS59) were assessed during follow-up.
RESULTS: Ameloblastoma was the most frequent diagnosis (52.9% managed by IOA vs 70.6% by EOA); FFF was frequently positioned as double barrel (94.1% managed by IOA vs 88.2% by EOA). Compared with EOA group, IOA group had less intraoperative blood loss (mean difference [MD] = -112.2, 95% confidence interval [CI]: -178.9 to -45.5, p = 0.001), higher satisfaction score (MD = 1.3, 95% CI: 0.9 to 1.7, p ˂ 0.001), and lower DAS59 score (MD = -0.5, 95% CI: -0.7 to -0.2, p ˂ 0.001).
CONCLUSIONS: Both IOA and EOA were found safe and feasible, presenting similar perioperative features and postoperative outcomes. Patients managed with IOA were more satisfied with aesthetic outcomes than patients managed with EOA. In the absence of simultaneous immediate implant during mandibular FFF reconstruction, after stability of FFF on the defect site, patients should always be referred to an implantologist and/or prosthodontist for teeth restoration to improve functional and aesthetic outcomes.
OBJECTIVE: To compare IOA vs EOA of segmental mandibulectomy and microvascular reconstruction with fibula free flap (FFF).
METHODS: We conducted a retrospective cohort study in which 51 patients who underwent segmental mandibulectomy and microvascular reconstruction with FFF from 2020 to 2024 were included, especially 17 patients by IOA and 34 patients by EOA, representing both groups of this study. Clinical characteristics, surgery parameters, and patients\' prognosis were evaluated. Patients\' satisfaction and Derriford Appearance Scale (DAS59) were assessed during follow-up.
RESULTS: Ameloblastoma was the most frequent diagnosis (52.9% managed by IOA vs 70.6% by EOA); FFF was frequently positioned as double barrel (94.1% managed by IOA vs 88.2% by EOA). Compared with EOA group, IOA group had less intraoperative blood loss (mean difference [MD] = -112.2, 95% confidence interval [CI]: -178.9 to -45.5, p = 0.001), higher satisfaction score (MD = 1.3, 95% CI: 0.9 to 1.7, p ˂ 0.001), and lower DAS59 score (MD = -0.5, 95% CI: -0.7 to -0.2, p ˂ 0.001).
CONCLUSIONS: Both IOA and EOA were found safe and feasible, presenting similar perioperative features and postoperative outcomes. Patients managed with IOA were more satisfied with aesthetic outcomes than patients managed with EOA. In the absence of simultaneous immediate implant during mandibular FFF reconstruction, after stability of FFF on the defect site, patients should always be referred to an implantologist and/or prosthodontist for teeth restoration to improve functional and aesthetic outcomes.
摘要：
背景：可以通过口内入路（IOA）或口外入路（EOA）进行节段性下颌骨切除术和重建缺损。这两种方法都有优势，缺点,适应症,以及在选择时要考虑的禁忌症。
目的：比较节段性下颌骨切除和腓骨游离皮瓣（FFF）微血管重建的IOA与EOA。
方法：我们进行了一项回顾性队列研究，纳入了从2020年到2024年接受节段性下颌骨切除术和FFF微血管重建的51例患者，尤其是17例IOA患者和34例EOA患者，代表本研究的两组。临床特征,手术参数,并对患者预后进行评估。随访期间评估患者满意度和Derriford外观量表（DAS59）。
结果：成釉细胞瘤是最常见的诊断（IOA管理52.9％，EOA管理70.6％）；FFF通常定位为双桶（IOA管理94.1％，EOA管理88.2％）。与EOA组相比,IOA组的术中失血较少（平均差异[MD]=-112.2，95％置信区间[CI]：-178.9至-45.5，p=0.001），满意度得分较高(MD=1.3，95%CI：0.9至1.7，p<0.001)，和较低的DAS59评分（MD=-0.5，95%CI：-0.7至-0.2，p<0.001）。
结论：IOA和EOA都是安全可行的，具有相似的围手术期特征和术后结局。与接受EOA治疗的患者相比，接受IOA治疗的患者对美学结果更满意。在下颌骨FFF重建期间没有同时立即植入，FFF在缺陷部位稳定后，应始终将患者转介给植入医师和/或修复医师进行牙齿修复，以改善功能和美学结果。
目的：比较节段性下颌骨切除和腓骨游离皮瓣（FFF）微血管重建的IOA与EOA。
方法：我们进行了一项回顾性队列研究，纳入了从2020年到2024年接受节段性下颌骨切除术和FFF微血管重建的51例患者，尤其是17例IOA患者和34例EOA患者，代表本研究的两组。临床特征,手术参数,并对患者预后进行评估。随访期间评估患者满意度和Derriford外观量表（DAS59）。
结果：成釉细胞瘤是最常见的诊断（IOA管理52.9％，EOA管理70.6％）；FFF通常定位为双桶（IOA管理94.1％，EOA管理88.2％）。与EOA组相比,IOA组的术中失血较少（平均差异[MD]=-112.2，95％置信区间[CI]：-178.9至-45.5，p=0.001），满意度得分较高(MD=1.3，95%CI：0.9至1.7，p<0.001)，和较低的DAS59评分（MD=-0.5，95%CI：-0.7至-0.2，p<0.001）。
结论：IOA和EOA都是安全可行的，具有相似的围手术期特征和术后结局。与接受EOA治疗的患者相比，接受IOA治疗的患者对美学结果更满意。在下颌骨FFF重建期间没有同时立即植入，FFF在缺陷部位稳定后，应始终将患者转介给植入医师和/或修复医师进行牙齿修复，以改善功能和美学结果。
