Outcomes of Mandible Reconstruction Using Surgeon‐Specific, Patient‐Specific, and Conventional Plates

OBJECTIVE: To compare operative metrics, postoperative complications, and radiographic osseous union among surgeon-specific plates (SSPs), patient-specific plates (PSPs), and conventional un-bent plates (CPs) in microvascular mandibular reconstruction. METHODS: A retrospective review was performed of 171 patients who underwent osseous mandibular free flap reconstruction from January 2020-January 2025. Patients were stratified by plating technique: SSP (n = 52), PSP with computer-aided design/manufacture (CAD/CAM) (n = 58), and CP (n = 61). Primary outcomes included operative time, hospital length of stay, and postoperative complications. Secondary outcomes included osteotomy characteristics, CT-based radiographic osseous union, and time-to-Grade 2 union. Multivariate analysis evaluated factors associated with nonunion. RESULTS: Baseline demographics, defect characteristics, and radiation exposure were comparable across cohorts. Secondary reconstruction procedures were more frequent in the SSP cohort compared with the PSP cohort (p = 0.05), and SSPs were more commonly used in complete (angle to angle) mandibular reconstructions. Operative time, hospital length of stay, and ischemia time did not differ significantly by plating method. Postoperative complication rates were low and similar across groups, with no significant differences in infection, hematoma, or reoperation; however, low event rates may have limited power to detect small but clinically meaningful differences between cohorts. Radiographic nonunion was uncommon and did not differ by plating. Time-to-Grade 2 osseous union was similar across plating strategies. Multivariate analysis demonstrated a significant association between nonunion and postoperative complications. Inter-rater reliability for union grading was high. CONCLUSION: Microvascular mandibular reconstruction demonstrates comparable clinical and radiographic outcomes regardless of plate selection. Plate selection and CAD/CAM use should be driven by surgeon choice and reconstructive complexity.