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Carcinoma of the mandible is a disease that evokes images of devastating functional and cosmetic outcomes. Most of these malignancies require treatment with surgical resection and perioperative irradiation (XRT). To minimize the incidence of postoperative complications, the timing of perioperative XRT has been questioned. This study reviewed 140 patients at M.D. Anderson Cancer Center over a 7-year period who underwent mandibular resection and reconstruction with a free fibular flap. The patients were divided into the following four groups: (1) preoperative XRT followed by immediate reconstruction, (2) preoperative XRT followed by delayed reconstruction, (3) postoperative XRT, and (4) no XRT. The complications studied included exposure of bone and hardware, orocutaneous fistula, osteoradionecrosis, partial and complete flap loss, and severe cervical contractures. Of the 140 patients studied, 59 (42%) had at least one complication. Complications per group were the following: group 1, 45%; group 2, 46%; group 3, 47%; and group 4, 28%. The results show that the incidence of complications is relatively equal between groups that received preoperative vs. postoperative XRT.