Outcomes of mandibular reconstruction using conventional plates vs patient-specific implants.

Abstract

Recent progress using computer-aided design and computer-aided manufacturing technology has enabled the fabrication of surgical guides and reconstruction plates tailored to individual patients. These patient-specific implants (PSI), which are now being widely used for mandibular reconstruction surgery for oral cancer, have improved the efficiency of surgery and have allowed more precise execution of the preoperative plan. The present study compared the efficacy of PSI with conventional reconstruction plates (CR) requiring bending for mandibular reconstruction following segmental and hemimandibular resection in patients with an oral malignancy who underwent free-flap reconstruction including a reconstruction or bridging plate without bone. Thirty-nine patients from the previous 8 years were analyzed, including 21 with PSI-based reconstructions and 18 with CR. The median follow-up period was 1322 days (range 91-3225). Soft-tissue reconstruction was performed using an anterolateral thigh flap in all cases. The PSI group demonstrated a significantly shorter operative time (P = 0.0002), reduced intraoperative blood loss (P = 0.0039), and no instances of plate-related infection compared to three cases in the CR group. These findings highlighted the advantages of PSI for improving surgical efficiency and minimizing the burden on the patient, particularly in patients with free-flap mandibular reconstructions without microvascular bone flaps, such as a fibular or iliac crest flap.