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.

Authors

Mohamed Abdeldayem, Shady Hassan, Mariam Mohamed, Naglaa Shoukry

Published in

Maxillofacial plastic and reconstructive surgery. Jul 21, 2026. Epub Jul 21, 2026.

Abstract

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.
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.
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.
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.

PMID:
42479267
Bibliographic data and abstract were imported from PubMed on 21 Jul 2026.

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