Clinical Feasibility and Early Outcomes of Preoperative Three-Dimensional Modeling Techniques in Complex Maxillofacial Surgery: A Prospective Clinical Study

Clinical Feasibility and Early Outcomes of Preoperative Three-Dimensional Modeling Techniques in Complex Maxillofacial Surgery: A Prospective Clinical Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Clinical Feasibility and Early Outcomes of Preoperative Three-Dimensional Modeling Techniques in Complex Maxillofacial Surgery: A Prospective Clinical Study Majdi Khaled Jubari, Salah M. Bin Hafedh, Mohammed Hadi Al-Quhali This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8242530/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Virtual surgical planning (VSP) with stereolithographic (SLA) models and patient‑specific cutting guides has improved geometric fidelity and operating room efficiency in complex maxillofacial reconstruction [1–3,22]. Objective: To evaluate feasibility and early outcomes of a three‑phase preoperative 3D modeling workflow (planning → modeling → surgery) in a prospective cohort. Methods: Five consecutive patients (2017–2018) underwent VSP, SLA model fabrication, and intraoperative application for mandibular tumor resections with reconstruction or complex facial trauma. Primary outcomes were intraoperative feasibility/plate fit and perioperative complications; secondary outcomes included operation duration and early satisfaction. Results: Four resections required reconstruction (fibula free flap n=3; iliac crest graft n=1); one trauma case used pre‑bent plates. No intra‑ or early postoperative complications occurred; all patients reported early satisfaction. Conclusions: The workflow was feasible and safe with favorable early outcomes, aligning with contemporary evidence for VSP‑guided reconstruction [1–3,6–9,22]. Biological sciences/Cancer Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Oncology virtual surgical planning stereolithography patient‑specific cutting guides fibula free flap mandibular reconstruction pre‑bent plates maxillofacial surgery Figures Figure 1 Figure 2 Figure 3 Introduction Restoration of mandibular continuity and facial symmetry after tumor ablation or trauma is among the most challenging tasks in oral and maxillofacial surgery. Conventional freehand planning relies on 2D imaging and intraoperative judgement, which may limit visualization of complex 3D relationships and increase plate‑bending and fitting time [ 11 , 21 ]. Virtual surgical planning (VSP) links high‑resolution CT imaging to CAD/CAM and additive manufacturing, allowing simulation of resections and osteotomies, donor‑site planning, and fabrication of patient‑specific cutting guides and prebent plates, while facilitating dental rehabilitation and, when combined with intraoperative navigation, transfer of the virtual plan to the operative field [ 1 – 3 , 6 – 10 , 12 – 13 , 15 , 22 , 25 – 27 , 31 ]. Despite these advantages, comparative analyses are hindered by inconsistent accuracy metrics—linear distances, angular deviations, surface‑to‑surface maps, and occlusal outcomes—across studies [ 3 , 16 , 20 , 28 – 29 ]. Consensus frameworks from radiology and engineering emphasize quality assurance (QA) across the printing pipeline (image acquisition, segmentation, model generation, and device fabrication) to ensure traceable accuracy [ 16 – 20 ]. Beyond vendor‑based fabrication, point‑of‑care (POC) 3D printing and in‑house VSP have gained momentum across dental and maxillofacial applications, potentially reducing cost and lead times without compromising quality when appropriate QA is implemented [ 14 – 15 , 18 – 19 , 31 , 38 ]. Patient‑specific implants (PSIs), custom mandibular plates, and model‑based prebent plates have been associated with improved contouring, reliable reconstruction with fibula and iliac crest grafts, and, in some series, lower plate‑related complications and favorable functional outcomes [ 4 – 5 , 8 , 12 – 13 , 26 – 27 , 30 , 32 – 33 ]. In resource‑limited settings, barriers include access to engineering support, device and software costs, and logistics for model and guide production. Nevertheless, a growing body of clinical and technical work on navigation‑assisted reconstruction, patient‑specific plates, and implant‑related 3D printing has illustrated practical implementation pathways and outcomes across diverse centers [ 10 ],[ 12 ],[ 13 ],[ 15 ],[ 24 ],[ 30 ],[ 32 ],[ 33 ]. Demonstrating feasibility with clinically meaningful outcomes in such environments is essential to inform implementation. We therefore conducted a prospective observational cohort using a standardized three‑phase workflow, and here report aggregated early outcomes to enable journal‑length presentation and comparison with the broader literature. Materials and Methods Study design and setting: Prospective, single‑center observational cohort at a tertiary maxillofacial unit in Wuhan, China (Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology). The study was designed and reported in line with STROBE recommendations for observational studies and relevant institutional and journal guidance [ 34 ],[ 35 ],[ 36 ],[ 37 ]. The study protocol was reviewed and approved by the Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, and written informed consent was obtained from all participants (or their legal guardians) for treatment and de‑identified publication. Participants and indications: Consecutive patients requiring complex maxillofacial procedures where VSP and model‑guided techniques were expected to materially improve planning and execution were included. Indications comprised segmental mandibular resection with reconstruction (benign tumors) and complex facial fractures requiring accurate realignment and fixation. Exclusion criteria were incomplete imaging datasets or refusal of consent. Imaging and segmentation: Thin‑slice (≤ 1 mm) helical CT of the craniofacial skeleton was acquired according to standard protocols; donor‑site CT (lower extremity or iliac crest) was obtained when reconstructive grafting was anticipated. DICOM data were segmented to generate 3D meshes of the mandible, maxillofacial skeleton, and donor bone, with attention to preserving cortical contours and critical landmarks for later accuracy assessment [ 16 – 18 ]. Virtual planning: Using CAD software, surgeons and biomedical engineers collaboratively defined resection margins, osteotomy planes, and graft geometry (e.g., segment lengths and orientations for fibula flaps). For trauma, fragment repositioning to pre‑injury alignment was simulated. The virtual plan included targeted plate contouring and screw trajectories where applicable [ 22 – 23 , 25 ]. Model and guide fabrication: Stereolithographic (SLA) anatomical models of recipient and donor sites were fabricated. Patient‑specific cutting guides were produced for the mandible and donor bone, and a rigid plate‑templating model was used to prebend reconstruction plates ex vivo. QA steps—visual inspection, fit‑check on models, and verification of guide seating—were performed before sterilization [ 16 – 20 , 21 ]. Surgical application: Guided segmental resection and osteotomies were performed. For mandibular defects, fibula free‑flap segments were inset per plan and the prebent reconstruction plate was secured; iliac crest grafting was used in one case. In the trauma case, pre‑bent plates facilitated reduction and fixation. Intraoperative judgement addressed soft‑tissue considerations and minor adjustments to achieve passive fit and occlusal goals. Outcomes and analysis: Primary endpoints were intraoperative feasibility (subjective ease of application and plate fit) and perioperative complications (intraoperative events; 30‑day postoperative complications including vascular crisis, flap loss, infection, malocclusion, and plate fracture). Secondary endpoints included operation duration and early patient‑reported satisfaction with facial contour. Given the small n, analysis was descriptive (counts, medians). The overall three‑phase preoperative three‑dimensional modeling workflow (planning → modeling → surgery) is depicted in Fig. 3 . Results Cohort characteristics and case mix Five patients were treated during the study interval. Four underwent segmental mandibular resection with reconstruction—three with fibula free flap (FFF) and one with iliac crest graft—while one patient underwent reconstruction after complex maxillofacial fractures using pre‑bent plates. The distribution of procedures is shown in Fig. 1 . The case mix and reconstructive methods for all patients are summarised in Table 1 . Table 1 Case mix and reconstructive method (n = 5) Category Count (n) Fibula free flap 3 Iliac crest graft 1 Post‑trauma pre‑bent plates 1 Intraoperative application and early outcomes Across the cohort, intraoperative application was smooth with satisfactory plate adaptation. There were no intraoperative or early postoperative complications, no flap losses, and no early plate fractures. All patients reported early satisfaction with facial contour. Table 2 summarizes aggregated outcomes. Utilization of the individual components of the preoperative three‑dimensional modeling workflow across the five cases is illustrated in Fig. 2 . Table 2 Early outcomes (30 days) Outcome Value Intraoperative complications 0 Postoperative complications 0 Flap loss 0 Plate fracture (early) 0 Patient‑reported satisfaction (n/5) 5 Discussion Positioning and novelty. Virtual surgical planning and model-assisted reconstruction are increasingly adopted; our contribution is an implementation-focused feasibility series demonstrating consistent early outcomes across mixed indications in a resource-variable environment using a standardized three‑phase workflow (planning → modeling → surgery). This niche complements accuracy-focused studies by highlighting operational steps and quality assurance that enable safe uptake. Principal findings: A standardized VSP‑guided 3D modeling workflow was feasible and produced favorable early outcomes in five complex maxillofacial surgeries without perioperative complications. These findings are consistent with contemporary literature indicating improved geometric fidelity and efficiency when virtual planning, patient‑specific guides, and prebent plates are used [ 1 – 3 , 6 – 9 , 22 , 25 – 27 , 31 ]. Accuracy and metrics: Our qualitative assessment (fit to plan, contour) aligns with prior accuracy studies demonstrating close correspondence between planned and postoperative geometry with VSP [ 3 , 22 , 25 ]. However, heterogeneity in accuracy metrics across studies complicates meta‑analysis; standardized 3D surface deviation maps and landmark‑based angular/linear metrics are recommended [ 16 , 20 , 28 – 29 ]. Workflow and resources: Model‑based plate prebending can reduce intraoperative manipulation and improve contour, potentially lowering plate‑related issues in selected series [ 4 , 8 , 26 – 27 ]. Centers adopting POC 3D printing should implement QA for imaging fidelity, segmentation traceability, printer calibration, and post‑processing, as emphasized in radiology and engineering guidance [ 16 – 19 ]. Comparators and generalizability: Although our observational design and small sample size preclude causal inference, the aggregate results mirror matched comparisons and case series reporting reduced operative time, high plan adherence, and satisfactory functional outcomes with VSP‑guided reconstruction and orthognathic surgery when compared with conventional freehand techniques [ 1 – 3 , 6 – 9 , 22 , 24 , 30 , 32 – 33 ]. The absence of complications in our cohort must be interpreted cautiously; nonetheless, these data support feasibility in mixed‑resource contexts where careful case selection and workflow adaptation are required. Limitations: Small sample size, single‑center experience, and lack of quantitative postoperative accuracy or validated patient‑reported outcome measures. Future directions include standardized accuracy reporting, cost‑effectiveness analyses of vendor vs POC production, and multicenter registries to harmonize metrics and outcomes [ 14 , 18 – 20 , 25 , 38 – 40 ]. Conclusion Preoperative 3D modeling integrated with VSP, SLA anatomical models, patient‑specific cutting guides, and prebent plates was feasible and safe in a prospective series of complex maxillofacial procedures. Early outcomes were favorable with universal patient satisfaction and no perioperative complications. These observations align with multi‑study evidence and support careful expansion of VSP‑guided reconstruction, paired with rigorous QA and standardized accuracy reporting to facilitate cross‑study comparisons and implementation in resource‑constrained environments [ 1 – 3 , 16 – 20 , 22 , 25 – 27 ]. Declarations Ethics approval and consent to participate The study was conducted as a prospective, single‑center observational cohort at the Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. The study protocol was reviewed and approved by the Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. All procedures involving human participants were carried out in accordance with institutional ethical standards and the 1964 Helsinki Declaration and its later amendments. All patients (or their legal guardians) provided written informed consent to participate in the study and to undergo the planned surgical procedures. Clinical trial number: not applicable. Consent for publication Written informed consent for publication of de‑identified clinical details and illustrative images was obtained from all participants (or from their legal guardians in the case of minors). Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not‑for‑profit sectors. Author Contribution MKAJ conceived and designed the study, collected the clinical data and performed the maxillofacial surgeries. SMBH contributed to study methodology, data interpretation, drafting of the manuscript and overall supervision. MHAQ contributed to investigation, surgical application and critical revision of the manuscript. All authors read and approved the final manuscript. Data Availability The de‑identified datasets generated and/or analysed during the current study are not publicly available due to institutional restrictions on patient data sharing but are available from the corresponding author on reasonable request. 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09:40:29","extension":"xml","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":79377,"visible":true,"origin":"","legend":"","description":"","filename":"b0fcee2cd41241d18373bef2c1be4e7c1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8242530/v1/f5f486fc47dc3a4b3cfeac61.xml"},{"id":98758544,"identity":"c5f27ca7-c8fc-402b-8fb4-ee9c2522ab92","added_by":"auto","created_at":"2025-12-22 09:40:25","extension":"html","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":92413,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8242530/v1/f5ebe420fd052c796801c825.html"},{"id":98758565,"identity":"b9b50253-5ce6-4268-81a1-85a4d0034600","added_by":"auto","created_at":"2025-12-22 09:40:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":95781,"visible":true,"origin":"","legend":"\u003cp\u003eCase mix distribution (pie).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8242530/v1/50ac962406f8c77c40d8623b.png"},{"id":98758570,"identity":"5c7d130d-698e-4fb4-b260-9e9b5e20589d","added_by":"auto","created_at":"2025-12-22 09:40:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":145285,"visible":true,"origin":"","legend":"\u003cp\u003eUtilization of planned components across cases (bar).\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8242530/v1/4dee9f9119971e976fe21559.png"},{"id":98758617,"identity":"e0bd90db-e851-449e-b945-6958579c6352","added_by":"auto","created_at":"2025-12-22 09:40:30","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":132741,"visible":true,"origin":"","legend":"\u003cp\u003eThree‑phase preoperative 3D modeling workflow (planning → modeling → surgery).\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8242530/v1/e527bc111cc0fd3330dbff71.png"},{"id":102211785,"identity":"b7d8be5e-fc6e-48bf-aa77-9eca860c76d1","added_by":"auto","created_at":"2026-02-09 12:28:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":827854,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8242530/v1/529364ee-3bb4-4528-b4d7-131649e75c1a.pdf"},{"id":98758587,"identity":"eb59a277-ded9-4fe9-a41e-e4aec075d344","added_by":"auto","created_at":"2025-12-22 09:40:28","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":37678,"visible":true,"origin":"","legend":"","description":"","filename":"STROBEChecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-8242530/v1/5aa6ef616aece5d780f0f4bb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Feasibility and Early Outcomes of Preoperative Three-Dimensional Modeling Techniques in Complex Maxillofacial Surgery: A Prospective Clinical Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRestoration of mandibular continuity and facial symmetry after tumor ablation or trauma is among the most challenging tasks in oral and maxillofacial surgery. Conventional freehand planning relies on 2D imaging and intraoperative judgement, which may limit visualization of complex 3D relationships and increase plate‑bending and fitting time [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVirtual surgical planning (VSP) links high‑resolution CT imaging to CAD/CAM and additive manufacturing, allowing simulation of resections and osteotomies, donor‑site planning, and fabrication of patient‑specific cutting guides and prebent plates, while facilitating dental rehabilitation and, when combined with intraoperative navigation, transfer of the virtual plan to the operative field [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these advantages, comparative analyses are hindered by inconsistent accuracy metrics\u0026mdash;linear distances, angular deviations, surface‑to‑surface maps, and occlusal outcomes\u0026mdash;across studies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Consensus frameworks from radiology and engineering emphasize quality assurance (QA) across the printing pipeline (image acquisition, segmentation, model generation, and device fabrication) to ensure traceable accuracy [\u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBeyond vendor‑based fabrication, point‑of‑care (POC) 3D printing and in‑house VSP have gained momentum across dental and maxillofacial applications, potentially reducing cost and lead times without compromising quality when appropriate QA is implemented [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Patient‑specific implants (PSIs), custom mandibular plates, and model‑based prebent plates have been associated with improved contouring, reliable reconstruction with fibula and iliac crest grafts, and, in some series, lower plate‑related complications and favorable functional outcomes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn resource‑limited settings, barriers include access to engineering support, device and software costs, and logistics for model and guide production. Nevertheless, a growing body of clinical and technical work on navigation‑assisted reconstruction, patient‑specific plates, and implant‑related 3D printing has illustrated practical implementation pathways and outcomes across diverse centers [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e],[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e],[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e],[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e],[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e],[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e],[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e],[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Demonstrating feasibility with clinically meaningful outcomes in such environments is essential to inform implementation. We therefore conducted a prospective observational cohort using a standardized three‑phase workflow, and here report aggregated early outcomes to enable journal‑length presentation and comparison with the broader literature.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eStudy design and setting: Prospective, single‑center observational cohort at a tertiary maxillofacial unit in Wuhan, China (Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology). The study was designed and reported in line with STROBE recommendations for observational studies and relevant institutional and journal guidance [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e],[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e],[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e],[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The study protocol was reviewed and approved by the Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, and written informed consent was obtained from all participants (or their legal guardians) for treatment and de‑identified publication.\u003c/p\u003e \u003cp\u003eParticipants and indications: Consecutive patients requiring complex maxillofacial procedures where VSP and model‑guided techniques were expected to materially improve planning and execution were included. Indications comprised segmental mandibular resection with reconstruction (benign tumors) and complex facial fractures requiring accurate realignment and fixation. Exclusion criteria were incomplete imaging datasets or refusal of consent.\u003c/p\u003e \u003cp\u003eImaging and segmentation: Thin‑slice (\u0026le;\u0026thinsp;1 mm) helical CT of the craniofacial skeleton was acquired according to standard protocols; donor‑site CT (lower extremity or iliac crest) was obtained when reconstructive grafting was anticipated. DICOM data were segmented to generate 3D meshes of the mandible, maxillofacial skeleton, and donor bone, with attention to preserving cortical contours and critical landmarks for later accuracy assessment [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVirtual planning: Using CAD software, surgeons and biomedical engineers collaboratively defined resection margins, osteotomy planes, and graft geometry (e.g., segment lengths and orientations for fibula flaps). For trauma, fragment repositioning to pre‑injury alignment was simulated. The virtual plan included targeted plate contouring and screw trajectories where applicable [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eModel and guide fabrication: Stereolithographic (SLA) anatomical models of recipient and donor sites were fabricated. Patient‑specific cutting guides were produced for the mandible and donor bone, and a rigid plate‑templating model was used to prebend reconstruction plates ex vivo. QA steps\u0026mdash;visual inspection, fit‑check on models, and verification of guide seating\u0026mdash;were performed before sterilization [\u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSurgical application: Guided segmental resection and osteotomies were performed. For mandibular defects, fibula free‑flap segments were inset per plan and the prebent reconstruction plate was secured; iliac crest grafting was used in one case. In the trauma case, pre‑bent plates facilitated reduction and fixation. Intraoperative judgement addressed soft‑tissue considerations and minor adjustments to achieve passive fit and occlusal goals.\u003c/p\u003e \u003cp\u003eOutcomes and analysis: Primary endpoints were intraoperative feasibility (subjective ease of application and plate fit) and perioperative complications (intraoperative events; 30‑day postoperative complications including vascular crisis, flap loss, infection, malocclusion, and plate fracture). Secondary endpoints included operation duration and early patient‑reported satisfaction with facial contour. Given the small n, analysis was descriptive (counts, medians). The overall three‑phase preoperative three‑dimensional modeling workflow (planning \u0026rarr; modeling \u0026rarr; surgery) is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eCohort characteristics and case mix\u003c/p\u003e \u003cp\u003eFive patients were treated during the study interval. Four underwent segmental mandibular resection with reconstruction\u0026mdash;three with fibula free flap (FFF) and one with iliac crest graft\u0026mdash;while one patient underwent reconstruction after complex maxillofacial fractures using pre‑bent plates. The distribution of procedures is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The case mix and reconstructive methods for all patients are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCase mix and reconstructive method (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCount (n)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFibula free flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIliac crest graft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost‑trauma pre‑bent plates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eIntraoperative application and early outcomes\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAcross the cohort, intraoperative application was smooth with satisfactory plate adaptation. There were no intraoperative or early postoperative complications, no flap losses, and no early plate fractures. All patients reported early satisfaction with facial contour. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes aggregated outcomes. Utilization of the individual components of the preoperative three‑dimensional modeling workflow across the five cases is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEarly outcomes (30 days)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlap loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlate fracture (early)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient‑reported satisfaction (n/5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePositioning and novelty. Virtual surgical planning and model-assisted reconstruction are increasingly adopted; our contribution is an implementation-focused feasibility series demonstrating consistent early outcomes across mixed indications in a resource-variable environment using a standardized three‑phase workflow (planning \u0026rarr; modeling \u0026rarr; surgery). This niche complements accuracy-focused studies by highlighting operational steps and quality assurance that enable safe uptake.\u003c/p\u003e \u003cp\u003ePrincipal findings: A standardized VSP‑guided 3D modeling workflow was feasible and produced favorable early outcomes in five complex maxillofacial surgeries without perioperative complications. These findings are consistent with contemporary literature indicating improved geometric fidelity and efficiency when virtual planning, patient‑specific guides, and prebent plates are used [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccuracy and metrics: Our qualitative assessment (fit to plan, contour) aligns with prior accuracy studies demonstrating close correspondence between planned and postoperative geometry with VSP [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, heterogeneity in accuracy metrics across studies complicates meta‑analysis; standardized 3D surface deviation maps and landmark‑based angular/linear metrics are recommended [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWorkflow and resources: Model‑based plate prebending can reduce intraoperative manipulation and improve contour, potentially lowering plate‑related issues in selected series [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Centers adopting POC 3D printing should implement QA for imaging fidelity, segmentation traceability, printer calibration, and post‑processing, as emphasized in radiology and engineering guidance [\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eComparators and generalizability: Although our observational design and small sample size preclude causal inference, the aggregate results mirror matched comparisons and case series reporting reduced operative time, high plan adherence, and satisfactory functional outcomes with VSP‑guided reconstruction and orthognathic surgery when compared with conventional freehand techniques [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The absence of complications in our cohort must be interpreted cautiously; nonetheless, these data support feasibility in mixed‑resource contexts where careful case selection and workflow adaptation are required.\u003c/p\u003e \u003cp\u003eLimitations: Small sample size, single‑center experience, and lack of quantitative postoperative accuracy or validated patient‑reported outcome measures. Future directions include standardized accuracy reporting, cost‑effectiveness analyses of vendor vs POC production, and multicenter registries to harmonize metrics and outcomes [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePreoperative 3D modeling integrated with VSP, SLA anatomical models, patient‑specific cutting guides, and prebent plates was feasible and safe in a prospective series of complex maxillofacial procedures. Early outcomes were favorable with universal patient satisfaction and no perioperative complications. These observations align with multi‑study evidence and support careful expansion of VSP‑guided reconstruction, paired with rigorous QA and standardized accuracy reporting to facilitate cross‑study comparisons and implementation in resource‑constrained environments [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThe study was conducted as a prospective, single‑center observational cohort at the Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. The study protocol was reviewed and approved by the Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. All procedures involving human participants were carried out in accordance with institutional ethical standards and the 1964 Helsinki Declaration and its later amendments. All patients (or their legal guardians) provided written informed consent to participate in the study and to undergo the planned surgical procedures. Clinical trial number: not applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eWritten informed consent for publication of de‑identified clinical details and illustrative images was obtained from all participants (or from their legal guardians in the case of minors).\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not‑for‑profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMKAJ conceived and designed the study, collected the clinical data and performed the maxillofacial surgeries. SMBH contributed to study methodology, data interpretation, drafting of the manuscript and overall supervision. MHAQ contributed to investigation, surgical application and critical revision of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe de‑identified datasets generated and/or analysed during the current study are not publicly available due to institutional restrictions on patient data sharing but are available from the corresponding author on reasonable request.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eWorkflow quality assurance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo enhance reproducibility and surgical safety, we applied a simple quality-assurance (QA) checklist across all cases: (1) independent review of the virtual plan by two surgeons; (2) verification of osteotomy planes and resection margins in orthogonal views; (3) inspection of the printed stereolithography (SLA) models and cutting guides for surface artifacts and fit; (4) pre-bending and labeling of fixation plates on the model with trial assembly; and (5) intraoperative verification of the planned bony landmarks before definitive cuts and fixation. Postoperative verification relied on surgeon logbook notes and photographic documentation; quantitative 3D deviation analysis was not performed and is planned for future work. This pragmatic QA approach aligns with contemporary guidance recommending explicit checks from virtual planning through intraoperative execution.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBarr, M. L. et al. Virtual Surgical Planning in Head and Neck Reconstruction. \u003cem\u003eJ. Oral Maxillofac. Surg.\u003c/em\u003e \u003cb\u003e78\u003c/b\u003e (7), 1158\u0026ndash;1168 (2020). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/32229178/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/32229178/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePowcharoen, W. et al. 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(2025). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.jprasurg.com/article/S1748-6815(25)00146-9/fulltext\u003c/span\u003e\u003cspan address=\"https://www.jprasurg.com/article/S1748-6815(25)00146-9/fulltext\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"virtual surgical planning, stereolithography, patient‑specific cutting guides, fibula free flap, mandibular reconstruction, pre‑bent plates, maxillofacial surgery","lastPublishedDoi":"10.21203/rs.3.rs-8242530/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8242530/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Virtual surgical planning (VSP) with stereolithographic (SLA) models and patient‑specific cutting guides has improved geometric fidelity and operating room efficiency in complex maxillofacial reconstruction [1–3,22].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eObjective: To evaluate feasibility and early outcomes of a three‑phase preoperative 3D modeling workflow (planning → modeling → surgery) in a prospective cohort.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: Five consecutive patients (2017–2018) underwent VSP, SLA model fabrication, and intraoperative application for mandibular tumor resections with reconstruction or complex facial trauma. Primary outcomes were intraoperative feasibility/plate fit and perioperative complications; secondary outcomes included operation duration and early satisfaction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Four resections required reconstruction (fibula free flap n=3; iliac crest graft n=1); one trauma case used pre‑bent plates. No intra‑ or early postoperative complications occurred; all patients reported early satisfaction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusions: The workflow was feasible and safe with favorable early outcomes, aligning with contemporary evidence for VSP‑guided reconstruction [1–3,6–9,22].\u003c/p\u003e","manuscriptTitle":"Clinical Feasibility and Early Outcomes of Preoperative Three-Dimensional Modeling Techniques in Complex Maxillofacial Surgery: A Prospective Clinical Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 09:39:11","doi":"10.21203/rs.3.rs-8242530/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7dcea1dc-ce91-422f-beb1-15dac1fd91da","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":59840640,"name":"Biological sciences/Cancer"},{"id":59840641,"name":"Health sciences/Diseases"},{"id":59840642,"name":"Health sciences/Health care"},{"id":59840643,"name":"Health sciences/Medical research"},{"id":59840644,"name":"Health sciences/Oncology"}],"tags":[],"updatedAt":"2026-02-09T12:27:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 09:39:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8242530","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8242530","identity":"rs-8242530","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}