## 3 Results

Table 2: Measurements of mandible growth on the day of surgery and during the follow-up (2–6 years postoperative), where MIOpre is maximal internicnsical opening before resection and reconstruction; MIOpost is maximal internicnical at the final follow-up; Ramus OP is the height of the operated ramus before surgery; Ramus OP is the height of the operated ramus after surgery; Body OP is the length of the operated body before surgery; Body OP is the length of the operated body after surgery; Ramus C is the height of the nonoperated ramus before surgery. Ramus C is the height of the nonoperated ramus after surgery. Battery. Battery \(\mathrm{IN}/\mathrm{A}\): as the procedure was done bilaterally in two patients there was no reference point for estimating the operated vs. nonoperated side for statistical purposes. In the follow-up, there were no statistical differences observed in height (\(p\) = 0.39) or in length (\(p\) = 0.14) (Figure 4) between the graft and the control. Therefore, the operated side exhibited similar growth of the ramus and body in comparison to the control at the endpoint of the study. The difference between the mean values of the SNB angles before and after surgery was significant (\(p\) = 0.000), which confirms that physiological anterioinferior growth of the mandible occurred after the surgery in all patients (Figure 5). The postoperative improvement in the range of mouth opening was statistically significant (\(p\) = 0.001) (Figure 6). Figure 4: Student’s \(t\)-test evaluating statistical differences in the mean growth of the ramus (**a**) and body (**b**) of the graft and healthy control. Statistical significance was established at \(p\) < 0.005. Figure 5: Student’s \(t\)-test evaluating statistical differences in the mean value of the SNB angle before and after surgery. Statistical significance was established at \(p\) < 0.005. Figure 6: Student’s \(t\)-test evaluating statistical differences in MIO (maximal interincisal opening) before and after the surgery. Statistical significance was established at \(p\) < 0.005. The average postoperative MIO was 38.75 mm (mean improvement of +13.75 mm), which confirms the beneficial effect of the surgery on mouth opening (Figure 7). During the follow-up, genital asymmetry of 3-6 mm was diagnosed in 8 patients (Table 2). The patterns of the ramus and body growth were analyzed using simple regression testing of the subgroups (operated vs. control) (Figure 8). During the follow-up period it was observed that, in some cases, the grafted side exhibited decreased potential for growth in comparison to the nonoperated side, but there was no statistically significant difference (\(p>0.005\)). There were no free flap failures in the postoperative period or during the 4-5-year follow-up. All patients exhibited satisfactory function of the TMJ, except for one patient, who had posterior dislocation of the TMJ prosthesis, which was treated by additional rehabilitation. Contralateral excursion was observed in five patients after reconstruction. There were no inflammatory complications or biomechanical problems with the prosthesis itself, such as dislocations or inappropriate positioning of the mandible. Furthermore, there were no incidents of the prosthesis loosening. All patients had orthodontic and dental implant treatment performed as the final stage of oral rehabilitation (Figure 9). In three patients, additional orthognathic surgery had to be undertaken. In another three patients, additional bone grafting was necessary due to the placement of the dental implants. Figure 8: Simple regression tests evaluating patterns of mandible growth, (**a**) Operated site, (**b**) Control site. It can be observed that the operated side exhibited decreased capacity for growth over time when compared with the healthy side. Statistical significance was established at \(p<0.005\). Figure 7: Photographs of an 8-year-old patient (**a**) before and (**b**) one year after the surgery, showing significant improvement in the range of mouth opening and satisfactory aesthetic results.