Introduction <p>Mandibular reconstruction in paediatric patients using vascularized fibula flaps is a complex surgical intervention with significant implications for growth and functional outcomes. Despite being practiced for decades, the long-term growth potential following this procedure remains uncertain, especially in the context of condylar preservation, patient age, and the underlying pathology.</p> Methods <p>A systematic review was conducted by analysing studies that reported on mandibular growth outcomes in paediatric patients following reconstruction with vascularized fibula flaps. The review focused on evaluating factors such as condylar preservation, age at surgery, lesion type, and the impact of postoperative therapies.</p> Results <p>The review included eight studies with a total of 180 paediatric patients. The findings indicated that over 50% of patients exhibited mandibular growth post-reconstruction. Condylar preservation was significantly associated with improved growth potential, particularly in patients undergoing surgery between 8 and 12 years of age. Benign lesions were more likely to result in continued growth compared to malignant ones. Postoperative radiation therapy was found to negatively impact growth potential, whereas chemotherapy had no significant effect.</p> Conclusion <p>The review suggests that careful consideration of condylar preservation whenever possible depending on patient age, and lesion type is crucial in optimizing growth outcomes following mandibular reconstruction with vascularized fibula flaps in paediatric patients. Further research is needed to elucidate the long-term effects and refine surgical approaches in this patient population.</p>