This retrospective study aims to evaluate and compare the morphological and functional characteristics of mandibular reconstructions performed using iliac and fibular flaps to determine their respective effectiveness and identify the technique that offers the best patient outcomes.

Medical and imaging data were analysed from pre- and post-operative scans of 121 patients (84 with iliac flaps and 37 with fibular flaps). Mandibular reconstructions were assessed by comparing morphometric parameters (distances and angles) and symmetry between the affected and unaffected sides using Mimics software. The quality of life of patients was assessed using a modified version of the University of Washington Quality of Life Questionnaire (UW-QOL), version 4, which evaluates functional and psychosocial outcomes in head and neck cancer treatment

The results show that the iliac group demonstrates significantly superior performance for distances D2 and D3 and for the CA angle on the unaffected side. In contrast, the fibular group shows no significant advantage in these parameters. Regarding symmetry, the iliac group achieves better results for distance D3, whereas the fibular group excels in angular measurements. Additionally, the iliac group maintains better stability for angle B. Regarding bone dimensions, the iliac flap better preserves alveolar base height (ABH) and width (ABW), providing more consistent and favorable outcomes than the fibular flap.No overall difference was observed between the two groups regarding quality of life (assessed using the UW-QOL questionnaire). However, specific variations were noted: the fibular group scores higher for pain, activity, and recreation, while the iliac group achieves better results in appearance and speech.

The iliac flaps are the preferred option for mandibular reconstruction, offering superior morphometric stability, better preservation of bone dimensions, and more robust structural consistency than fibular flaps. Although both techniques yield comparable overall quality-of-life results, iliac flaps demonstrate more pronounced clinical benefits, leading to optimal postoperative outcomes.