This chapter discusses oromandibular reconstruction, where ideal mandibular reconstruction, like any reconstructive effort should, as closely as possible, restore premorbid form and function. The symphysis promotes chin prominence and is chiefly responsible for the vertical height of the lower one-third of the face. The mentalis muscle is attached and serves as support for lower lip competence. The body supports posterior dentition and through it runs the inferior alveolar nerve providing sensation to the teeth, gums. A uniquely complex surface allows the condyle to move in three planes, such as vertical, rotational and translational, relative to the base of skull articulation. The coronoid, conversely, is often purposely removed in mandibular reconstruction to prevent uncontrolled upward and medial pull of the attached temporalis muscle, especially if prolonged inactivity and radiation producing fibrosis of this muscle is expected. The fundamental goal of bone grafting is to transfer osteocompetent cells to a tissue defect missing bone.