The ideal natural or prosthetic mandibular replacement should be adjustable at the time of surgery, completely stable, free from tissue reaction or rejection, rapidly incorporated into surrounding tissue, and unlimited in lifespan. A brief review of clinically utilized mandibular replacements is discussed in relation to the ideals. At this time the replacement most adequately satisfying these principles is autogenous cancellous bone and marrow supported by a titanium mesh trough. This article describes the details of external mandibular fixation and the reconstructive procedure including preoperative preparation and common postoperative complications. Modifications of the prosthesis and surgical technique are suggested in order to decrease the chances of postoperative exposure, a complication in any type of mandibular reconstruction.