Short-term outcomes of virtual surgical planning-assisted mandibular reconstruction using a patient-specific reconstruction plate and split rib bundle bone graft: a prospective single-arm study.

BACKGROUND: Mandibular reconstruction requires restoration of continuity, contour, and occlusion to achieve acceptable functional and aesthetic outcomes. Virtual surgical planning (VSP) and patient-specific reconstruction plates may improve preoperative planning and intraoperative reproduction of mandibular alignment. This study evaluated the short-term outcomes of VSP-assisted mandibular reconstruction using a patient-specific reconstruction plate and split rib bundle bone graft (SRBG) in selected patients with benign mandibular lesions.

METHODS: This prospective single-arm clinical study included 30 adult patients with benign mandibular lesions requiring segmental mandibulectomy and immediate reconstruction. All patients underwent preoperative thin-slice computed tomography, virtual surgical planning, and fabrication of a patient-specific reconstruction plate. Reconstruction was performed using a split rib bundle graft. Clinical and radiographic follow-up was conducted for 12 months. Outcomes included mandibular symmetry, landmark-based radiographic discrepancy, graft-volume change, postoperative pain, occlusion, 12-month graft survival, patient satisfaction, and complications.

RESULTS: The mean age was 37.23 ± 10.15 years, and 56.7% of patients were male. Postoperative asymmetry indices were lower than preoperative values at all measured landmarks (all p < 0.001), with the overall mean asymmetry index decreasing from 41.91 ± 5.32 preoperatively to 6.48 ± 2.46 postoperatively. Landmark-based discrepancy between the virtual plan and postoperative CT was low, with menton deviation of 0.053 ± 0.266. Mean graft volume decreased significantly over time from 15.61 ± 2.22 cm³ at baseline to 14.11 ± 2.13 cm³ at 12 months (p < 0.001). Stable postoperative occlusion was achieved in 28 patients (93.3%). Twelve-month graft survival was observed in 29 of 30 patients (96.7%), and 76.7% of patients were very satisfied, while 13.3% were satisfied. Complications were uncommon; one patient (3.3%) developed late plate loosening/removal requiring secondary surgical intervention.

CONCLUSION: VSP-assisted mandibular reconstruction using a patient-specific reconstruction plate and split rib bundle graft was feasible in this selected cohort of benign, nonirradiated mandibular defects, with acceptable short-term clinical and radiographic findings over 12 months. Because this was a single-arm study without a control group, with landmark-based radiographic assessment and limited follow-up, the results should be interpreted as descriptive feasibility data and should not be considered evidence of superiority, equivalence, or non-inferiority compared with conventional reconstruction, standard plates, or vascularized free-flap reconstruction.