Improved contour symmetry in complex mandibular reconstruction using virtual surgical planning

Mandibular reconstruction remains a challenge for reconstructive surgeons. Virtual surgical planning (VSP), using computer-aided design and modeling (CAD/CAM) technology, enhances precision in surgical planning and execution. However, its higher cost and longer preparation time raise concerns about its value across clinical scenarios. This study compared outcomes of VSP and conventional freehand techniques to identify when VSP provides a significant advantage in achieving contour symmetry. Patients who underwent free fibula osteoseptocutaneous flap surgery for mandibular reconstruction between January 2018 and August 2023 were reviewed. Postoperative symmetry was assessed via CT or MRI, focusing on gonial angle, mandibular body curve angle, body length, and distance from gonion to the midsagittal plane. Seventy-seven patients were included (31 VSP, 46 conventional). The VSP group had more osteotomies and longer bone segments. Imaging showed significantly smaller gonial angle deviation in the VSP group (4.5° vs. 16.0°; p = 0.03). In cases with two or more corner defects, VSP yielded smaller gonial angle deviation (2.0° vs. 30.0°; p = 0.02) and mandibular body curve angle deviation (4.0° vs. 17.0°; p = 0.003). Complication rates were similar between the groups. VSP improves contour symmetry in mandibular reconstruction, especially in complex cases involving multiple corner defects. In simpler cases, conventional techniques remain a viable option, allowing surgeons to achieve comparable outcomes while saving on time and expenses.