Background: The reconstruction of extensive facial bony defects using microvascular transplants requires extensive surgery to achieve the full rehabilitation of form and function. This prospective study evaluates the virtual planning tool ProPlan CMF to enhance the precision and efficiency of the reconstructions in 30 patients.

Material and methods: Between june 2011 and december 2012 thirty patients with virtual planned immediate or secondary microvascular reconstructions of bony and soft tissue defects of the mandible and maxilla were acquired for this study. The virtual planning was done using ProPlan CMF ^® . Based on a preoperative CT of the donor and defect site, the resection and osteotomies were virtually planned and were transferred to the operation theatre using guiding flanges. Furthermore, patient specific plates were bended according to a planned outcome model. Postoperatively, a CBCT was used to access the accuracy and precision of the acquired results in comparison to the virtual planned outcome.

Results: 30 patients were treated with 63 bone segments. The deviations between the virtual planning and the de facto postoperative situation were for the defect sizes + 1.17 mm (−21 to 2.56 mm), for the resection planes ± 1,69 mm (1.27–2.12 mm) and 10,16° (8.36–11.96°) and for the planes of the donor segments 10,81° (9.44–12.17°). The orientation of the segments differed by 6,68° (5.7–7.66°) from the virtual plan, the length of the segments differed by −0.12 mm (−0.89 to 0.65 mm) and + 0.17% (−2.47% to 2.80%], respectively, while the volume differed by −31.02% (−36.6% to −25.45%). The distance between the transplanted segments and the stumps were ± 1.49 mm (1.24–1.74 mm] and between the segments ± 1.49 mm (1.16–1.81 mm).

Conclusions: ProPlan CMF ^® is a reliable and precise tool for virtual planning of microvascular bony reconstructions in the head and neck.