Virtual surgical planning for midface reconstruction using osseous free flaps

The mid-face bony defects are challenging due to complex subunits anatomical considerations. This study aimed to evaluate the accuracy of virtual surgical planning for midface reconstruction utilising various osseous free flaps. A retrospective study was performed on patients with complex mid-face defects between 2019 and 2025. Virtual surgical planning (VSP) was utilized in all patients with microvascular osseous free flaps (n=78). A preoperative contrast-enhanced computed tomography (CT) of the head-and-neck region was required for VSP. Also, CT angiography of lower limbs in cases of fibula free flap, iliac bone in case of deep circumflex iliac artery (DCIA) free flap, and shoulder in case of scapula free flap were required for the design of the osteotomy guides and patient-specific plates. VSP workflow was designed by our team surgeons using Materialise software. Seventy-eight patients with complex mid-face defects were categorized according to the Brown classification of mid-face complex defects as follows: 37 class II, 9 bilateral class II, 27 class III, and 5 class IV. There were 30 females and 48 males. Reconstruction was a full computer-guided surgical protocol with 57 fibular free flaps, 9 DCIA, and 12 scapula free flaps. Dental rehabilitation was done in 72 patients (92.3%), by dental implants in 68 patients (87.1%), and removable prosthesis in the remaining 4 patients (5.1%). Aesthetic results were perfect (identical superimposition between preoperative virtual planning and postoperative CT). Preoperative VSP offers lots of benefits for patients with complex mid-face defects, dramatically reducing the operation time and efforts and magnificently improving the functional and aesthetic outcomes.