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Background: In the last half century the evolution of mandibular reconstruction has resulted in a multitude of surgical procedures that have been brought about by advances made in bone science, grafting techniques and materials technology. With the ever increasing number of surgical options currently available it has become essential to take stock of these achievements and reconsider the fundamental principles of reconstructive surgery.
Methods: The choice of reconstructive techniques is only part of a wider number of variables that must be considered which will ultimately determine the success or failure of the procedure.
Results: Variables likely to influence the outcome of mandibular reconstruction are the site and extent of the defect, the needs and tolerance of the patient, the timing of reconstruction and the surgical skill and techniques available.
Conclusion: By careful consideration of these cardinal variables it may be possible to formulate a treatment plan that will not only satisfy the essential needs of the patient but also help increase the likelihood of a successful outcome.

Over a 7-year period from January 1, 1983 to December 31, 1989, 439 maxillofacial injuries were referred to the Oral Surgery Department of St Mary's Hospital in London. During this period there was a decrease in the incidence of maxillofacial injuries presenting as a result of road traffic accidents, with a corresponding increase in the number of cases related to assault. The patterns of age and sex distribution, however, reflected the results of previous studies by other maxillofacial units within the UK. Of particular interest is the finding that a large proportion of maxillofacial injuries (43%) included in this survey had no active treatment