# Application of temporary patient-specific plate in head and neck osteocutaneous free flap reconstruction: a prospective pilot study

## TL;DR

This study tested a low-cost temporary plate to improve jaw reconstruction surgery, showing it is as effective as expensive custom plates.

## Contribution

Introduces a cost-effective temporary patient-specific plate for head and neck reconstructive surgery.

## Key findings

- The temporary plate achieved surgical accuracy comparable to traditional patient-specific plates.
- Operative times for plating and reconstruction were efficient with minimal implant complications.
- Distance and angular deviations were within acceptable clinical ranges.

## Abstract

During autologous osteocutaneous free flap transfer, the traditional process of manually contouring harvested bone segments to match the virtually planned jaw morphology is often imprecise and time-consuming. Consequently, the use of virtual surgical planning (VSP) and patient-specific surgical plates (PSPs) has gained substantial popularity in overcoming such challenges. However, the high costs and complex equipment required for manufacturing PSPs may render this technology inaccessible.

This study aimed to investigate the feasibility of developing a resin-made temporary patient-specific plate (TPSP) as an adjunct to improve the surgical efficiency and accuracy of reconstructive surgeries.

A prospective, single-centre study was performed. Patients indicated for computer-assisted free osteocutaneous flap reconstruction were recruited between December 2020 and October 2021.

Patient demographics, intraoperative characteristics, and postoperative outcomes were reviewed. Reconstruction accuracy was evaluated by comparing preoperative plans and postoperative models; the deviations and angulations of the reconstructed jaw, bone segments, and dental implants were measured.

Descriptive analysis was carried out.

Ten patients (seven men, three women) with a mean age of 52.9 ± 18.8 years were included in the study. In terms of surgical efficiency, the mean operative time was 492 ± 84.2 min, while the mean plating and reconstructive times were 58.7 ± 19.4 and 131.7 ± 26.4 min, respectively. A total of 26 simultaneous dental implants were placed in eight patients. One (3.8%) implant was abandoned due to intra-operative fenestration of the fibula bone, and one implant was explanted 12 months postoperatively. In terms of accuracy, the mean absolute distance deviation was 0.621 ± 0.548 (range: 0.0047–1.6277). The mean distance and deviation of the reconstructed segments were 5.16 ± 2.25 mm and 9.67° ± 6.84°, respectively. The mean distance deviations at the implant platform and apex were 3.94 ± 2.20 and 3.95 ± 2.97 mm, respectively, with a mean implant deviation of 12.8° ± 9.94°.

The use of TPSP proved to be a more affordable intraoperative alternative to PSP for aligning and stabilizing bony segments during flap inset while achieving surgical efficiency and accuracy comparable to those of PSP.