1 Oromandibular Reconstruction Using Microvascular Composite Free Flaps Report of 71 Cases and a New Classification Scheme for Bony, Soft-Tissue, and Neurologic Defects Mark L. Urken, MD; Hubert Weinberg, MD; Carin Vickery, MD; Daniel Buchbinder, DMD; William Lawson, DDS, MD; Hugh F. Biller, MD * We describe 71 cases of oromandibular reconstruction using microvascular composite free flaps. There was an overall flap success rate of 94%, while 97% of the patients in this series had their mandibles reconstructed with free vascularized bone flaps. Fifteen patients were rehabilitated with implant-borne dental prostheses. Primary repair of discontinuity defects of the inferior-alveolar nerve using a variety of nerve grafts was performed in 16 patients. A new classification scheme for composite defects of the oral cavity involving bone, soft tissue, and neurologic defects is proposed and applied in the description of each of the patients in this series. (Arch Otolaryngol Head Neck Surg. 1991;117:733-744) The restoration of normal oral function following ablative surgery or trauma depends on a variety of factors that include the reconstruction of complex osseous, dental, and soft-tissue anatomy. As all reconstructive surgeons are aware, this is only part of the problem in oral rehabilitation. The mobility of the mandible, tongue, cheeks, and soft palate are also important determinants of a successful outcome. In addition, the functional deficit associated with loss of sensation in the reconstructed oral cavity is readily apparent when oral function is critically assessed. Microvascular free tissue transfer has afforded the surgeon an opportunity to more critically address the aesthetic and functional outcome of oromandibular reconstruction due to the wide array of tissue that can be used. It is apparent from an analysis of these results that the extent of the deficit impacts greatly on the complexity of the reconstruction and the expectations for a favorable result. With the diverse range of vascularized and non-vascularized reconstructive methods available, it is impossible to form any basis of comparison without being able to accurately define the extent of the defect. A variety of classification schemes for segmental mandibular defects have been described. 1,2 However, as noted above, this greatly understates the magnitude of the problem. We propose a classification scheme for oromandibular defects that accounts for not only the bony, but also for the soft-tissue and neurologic defects. This scheme has been applied in describing 71 cases of oromandibular reconstruction using microvascular composite free flaps. This is the largest series of free flap reconstruction of composite oral defects to be reported in this literature. Classification of Mandibular Defects The classification of the bony component of composite oromandibular defects is an easier task than is classifying the soft-tissue component. Two classification schemes have been proposed