Scaffold-guided bone regeneration is poised to revolutionize the management of critical-sized bone defects. However, translation into clinical practice has been hampered by the focus on bioresorbable scaffolds where the rate of degradation needs to match the rate of bone formation and metal plates are required to overcome their mechanical limitations. Metal plates are problematic because they cause stress shielding and X-ray perturbation, increasing the likelihood of hardware failure and interfering with post-operative radiotherapy and imaging. Segmental defects of the mandible are challenging due to high tensile and shear stresses encountered during mastication, with the ovine mandible especially vexing because of the high repetitive loads. Here we show long-term reconstruction of ovine segmental mandibulectomy defects using a permanent, patient-matched, numerically optimized, 3D-printed, thermally toughened, plasma-treated, and laser-sintered polyetherketone gyroid scaffold housing a resorbable ceramic lattice infused with a stem cell laden hydrogel serving as an osteoinductive reservoir of calcium. The durable clinical performance observed indicates a translatable alternative to traditional reconstruction using bone grafts with metal plate fixation.

Background: The Jaw‐in‐a‐Day (JIAD) procedure aims to achieve immediate functional occlusion via a single‐stage approach to maxillofacial reconstruction. While JIAD has gained popularity since its inception by Levine and colleagues, efficacy and outcome data remain limited. In this report, we discuss our experience with the JIAD technique at an Australian tertiary referral centre. Methods: A retrospective review of all JIAD procedures performed from April 2022 to December 2023 was conducted. Clinicopathologic data reviewed included demographic information, primary diagnosis, anatomical site of disease, and history of pre‐operative radiotherapy. Outcome measures of interest included operative time, number of implants placed, post‐operative complications and implant survival. Results: Nineteen patients were identified for the study. Two maxillary and 17 mandibular JIAD procedures were performed. The most common indications were squamous cell carcinoma ( n = 8) and ameloblastoma ( n = 5). Surgical complications included recipient site wound infection ( n = 3), flap dehiscence ( n = 2), haematoma formation ( n = 1), and neck abscess associated with partial flap failure ( n = 1). No total flap failures were identified. Of the 55 total implants placed, one implant failure occurred 2‐months post‐operatively. No loss of irradiated implants ( n = 21) was observed. The median time to adjuvant radiotherapy was 57 days (range, 32–61). Eighteen of 19 patients (95%) achieved immediate dental rehabilitation, and 15/19 patients (79%) retained a functional prosthesis by the end of the follow‐up period. Conclusions: Our series supports the feasibility of single‐stage reconstruction for both benign and malignant indications. Further research is required to understand the long‐term functional, aesthetic, and health‐related quality‐of‐life outcomes with the JIAD technique.

Background: Digital surgical planning (DSP) has revolutionized the preparation and execution of the management of complex head and neck pathologies. The addition of virtual reality (VR) allows the surgeon to have a three‐dimensional experience with six degrees of freedom for visualizing and manipulating objects. This pilot study describes the participants experience with the first head and neck reconstructive VR‐DSP platform.Methods: An original VR‐DSP platform has been developed for planning the ablation and reconstruction of head and neck pathologies. A prospective trial utilizing this platform involving reconstructive surgeons was performed. Participants conducted a simulated VR‐DSP planning session, pre‐ and post‐questionnaire as well as audio recordings allowing for qualitative analysis.Results: Thirteen consultant reconstructive surgeons representing three surgical backgrounds with varied experience were recruited. The majority of surgeons had no previous experience with VR. Based on the system usability score, the VR‐DSP platform was found to have above average usability. The qualitative analysis demonstrated the majority had a positive experience. Participants identified some perceived barriers to implementing the VR‐DSP platform.Conclusions: Virtual reality‐digital surgical planning is usable and acceptable to reconstructive surgeons. Surgeons were able to perform the steps in an efficient time despite limited experience. The addition of VR offers additional benefits to current VSP platforms. Based on the results of this pilot study, it is likely that VR‐DSP will be of benefit to the reconstructive surgeon.