A single-arm clinical trial on segmental mandibulectomy and fibular flap reconstruction via a complete intraoral approach: introducing a new classification.

This single-arm trial aimed to compare the effectiveness of two surgical approaches, the intraoral approach (IOA) and the extraoral approach (EOA), to segmental mandibulactomy followed by immediate fibular free flap (FFF) reconstruction. In total, 7 patients with benign mandibular lesions were enrolled. Flap survival sever as the surgery success indicator. Patients were followed up for one year, with the Patient and Observer Scar Assessment Scale(POSAS) as the main outcome measure. Key parameters of 12 patients who underwent EOA during the same period were compared to evaluate the feasibility of the new method. All 7 patients successfully completed FFF microvascular reconstruction through IOA without serious complications. One year postoperatively, based on the follow-up assessment results of the POSAS scale, the score of the IOA group was significantly lower than that of the EOA. All patients were satisfied with the aesthetic and functional outcomes. Compared to the EOA group, there were no significant differences in defect type(p = 0.347), number of fibular segments(p = 0.354), hemoglobin level decrease(p = 0.223), or hospital stay (p = 0.790). However, the IOA resulted in a significantly longer operative time(p = 0.002). Reconstrction with the FFF through the IOA offers improved scar outcomes and higher patient satisfaction, thereby representing a favorable option for eligible patients.