Virtual Surgical Planning for Reconstruction of Mandibular Osteoradionecrosis: A Comparative Study on Its Safety and Outcomes

BACKGROUND: The role of virtual surgical planning (VSP) in mandibular osteoradionecrosis (ORN) surgery remains uncertain due to the challenges posed by irradiated tissues METHODS: A consecutive series of patients with mandibular ORN undergoing resection and reconstruction with vascularized hard-tissue free flaps between 1996 and 2004 was included. VSP was analyzed as a predictor variable for ORN recurrence, fixation plate removal, and malocclusion. RESULTS: Among 120 patients with mandibular ORN, 49 patients underwent VSP-guided resection and reconstruction. Multivariable Cox proportional hazards regression demonstrated a hazard ratio of 0.544 (95% CI: 0.098-3.010, p = 0.485) for ORN recurrence and 0.349 (95% CI: 0.145-0.841, p = 0.019) for plate removal. VSP was significantly associated with reduced malocclusion in 2 out of 30 dentate patients, compared to 10 out of 29 dentate patients in the non-VSP group (p = 0.010). CONCLUSIONS: VSP appears to be safe for ORN surgery with reduced rates of postoperative complications of plate removal and malocclusion.