Background: Microvascular osseous free flaps play a central role in head and neck reconstruction; surgeons often rely on fragmented and inconsistently reported data when counselling patients and planning reconstructive strategies. This systematic review and meta-analysis aimed to quantify postoperative complication rates and to evaluate complication patterns according to flap type. Methods: The study protocol was registered in PROSPERO (CRD420251237516). Studies published between January 2000 and November 2025 reporting postoperative complications following mandibular or maxillary reconstruction with osseous free flaps were identified. Eligible studies included adult cohorts with a minimum sample size of twenty patients. Random-effects meta-analyses of proportions were conducted. Risk of bias was assessed using the ROBINS-I tool. Results: Fourteen retrospective studies encompassing 1198 flaps were included. The pooled incidence of total flap loss was 6% (95% CI 3–9%), and partial flap loss was 6% (95% CI 3–10%). The pooled rates for postoperative infection, fistula formation, and wound dehiscence were 7% (95% CI 2–22%), 12% (95% CI 7–20%), and 16% (95% CI 8–31%), respectively, with substantial heterogeneity. Fibular free flaps demonstrated pooled rates of 6.1% for total flap loss, 6.6% for partial flap loss, 9.0% for infection, 10.4% for fistula formation, and 17.1% for wound dehiscence. For scapular free flaps, pooled total flap loss was 5% (95% CI 1–29%). DCIA flaps demonstrated hardware-related complications (8.1%), fistulas (16.7%), bone exposure (4.2%), and wound dehiscence (29.7%). Donor site morbidity was inconsistently reported and could not be quantitatively synthesized. Conclusions: Osseous free flap reconstruction shows relevant complication rates, highlighting the need for standardized reporting to support evidence-based decision-making.

Background: Reconstruction of the maxilla and midface remains one of the most demanding challenges in craniofacial surgery, requiring precise planning and a clear understanding of defect geometry to achieve functional and esthetic restoration. Advances in computer-assisted surgery (CAS) and virtual surgical planning (VSP), based on 3D segmentation of radiologic imaging, have significantly improved the management of maxillary deformities, allowing for further knowledge of patient-specific information, including anatomy, pathology, surgical planning, and reconstructive issues. The integration of computer-aided design and manufacturing (CAD/CAM) and 3D printing has further transformed reconstruction through customized titanium meshes, implants, and surgical guides. Methods:This systematic review, conducted following PRISMA 2020 guidelines, synthesizes evidence from clinical studies on CAD/CAM-assisted reconstruction of maxillary and midfacial defects of congenital, acquired, or post-resection origin. It highlights the advantages and drawbacks of maxillary reconstruction with patient-specific implants (PSISs). Primary outcomes are represented by accuracy in VSP reproduction, while secondary outcomes included esthetic results, functions, and assessment of complications. Results: Of the 44 identified articles, 10 met inclusion criteria with a time frame from April 2013 to July 2022. The outcomes of 24 treated patients are reported. CAD/CAM-guided techniques seemed to improve osteotomy accuracy, flap contouring, and implant adaptation. Conclusions: Although current data support the efficacy and safety of CAD/CAM-based approaches, limitations persist, including high costs, technological dependency, and variable long-term outcome data. This article critically evaluates the role of PSISs in maxillofacial reconstruction and outlines future directions for its standardization and broader adoption in clinical practice.

This case report of a 67‐year‐old patient shows reconstruction of the edentulous maxilla with all‐on‐four implant treatment involving soft tissue esthetics. Reconstruction of the edentulous maxilla involving soft tissue esthetics is a challenging clinical procedure and should be treated with an interdisciplinary approach. In this case report, complete‐arch guided soft tissue healing with an immediate interim prosthesis was applied following all‐on‐four implant placement. The immediate interim prosthesis helped achieve rapid prosthetic rehabilitation and guided soft tissue healing, resulting in an improved esthetic outcome, patient satisfaction, and acceptance for the treatment. Effective communication between surgeons, prosthodontists, and dental technicians made the process easy and successful during both implant placement and prosthetic rehabilitation.

A comparison of facial contour and patient-reported outcomes following zygomatic implant perforated (ZIP) flaps and fibular osseous flaps for maxillary reconstruction.

Three-dimensionally printed subperiosteal implants for maxillectomy reconstruction: report of nine cases.

Fully-guided placement of dental implants utilizing nasopalatine canal fixation in a novel rotational path surgical template design: A retrospective case series.

Reverse-planned patient specific implant with soft tissue flap for maxillary reconstruction and immediate full-arch dental rehabilitation

Total maxillectomy defects that involve both the supra- and infra-structure pose a reconstructive challenge. Accurate reconstruction of the orbital rim and alveolus is needed for orbital floor reconstruction and dental implant placement. The fibula is the workhorse flap for osseous craniofacial reconstruction. The distal fibula is harvested as vascularized bone while the proximal fibula is typically discarded after separating it from the pedicle. We evaluated the vascular anatomy of the proximal fibular segment for potential use as a separate bone flap. The anatomy of the peroneal vessels was studied in clinical cases and with computed tomographic angiograms. The branches of the proximal peroneal artery and vein were dissected during routine fibula flap harvest in 25 patients. Lower extremity computed tomographic angiograms of 100 limbs were also studied. We reconstructed a hemi-maxillectomy defect resulting from resection of salivary gland adenocarcinoma in a 69-year-old female, with a vascularized bone flap supplied by this proximal peroneal branch. The conventional fibula bone flap based on the peroneal vessels was used for alveolar reconstruction and the proximal fibula based on the proximal peroneal branch was used for inferior orbital rim reconstruction as a flow-through flap anastomosed to the distal end of the peroneal vessels. A polytetrafluoroethylene-titanium implant was used to recreate the orbital floor. In all fibula flap dissections and radiographic studies, a perforating branch of the peroneal vessels was seen supplying the proximal part of the fibula. The patient's postoperative course was uneventful, and adjuvant radiation was administered. At a follow-up of 1 year 3 months, the patient had excellent globe position, normal vision, and a moderate contour depression of the right cheek. The proximal fibula bone is consistently supplied by a branch of the peroneal vessels and can thus be harvested as a vascularized perforator bone flap.

Alveolar Cleft Reconstruction and Orthodontic Management of Patients with Cleft Lip-Palate.

Mandibular and maxillary reconstruction is commonly performed in the context of oncologic resection, trauma, osteomyelitis, osteonecrosis, and congenital malformation. The postoperative imaging evaluation of mandibular and maxillary reconstruction can be challenging to the radiologist not accustomed to reporting such cases. Familiarity with expected post-operative and post-therapeutic imaging appearances and possible complications is essential to convey accurately the findings to head and neck surgeons. The authors present a stepwise diagnostic algorithm to assist the radiologist in identifying key findings on imaging of patients with mandibular and maxillary reconstruction; describe the expected imaging findings in successful reconstruction; and review the early and late post-operative and post-therapeutic complications.

Computer-assisted surgery (CAS) has emerged as a transformative approach for oral and maxillofacial reconstruction, significantly enhancing surgical precision, efficiency, and patient outcomes. This review outlines the current status and future prospects of CAS, with a focus on its application in mandibular and maxillary reconstruction. CAS encompasses technologies such as virtual surgical planning (VSP), computer-aided design and manufacturing (CAD/CAM), and patient-specific plates (PSPs), which have become integral to procedures such as implant placement, orthognathic surgery, and fracture management. While Western countries have led the adoption of CAS, its implementation in Asia, including Japan, is steadily progressing and supported by innovations such as the domestically developed CAS system. Despite its advantages, CAS faces challenges, such as high costs, long preparation times, and limited intraoperative flexibility. This review highlights the clinical benefits, technological advancements, and regional developments in CAS, emphasizing the need for standardized evaluation methods, cost-effective solutions, and broader clinical integration to ensure sustainable and equitable access to advanced surgical care.

One-step primary complete rehabilitation following maxillectomy for a benign tumor: Advancements in midface reconstruction.

Abstract To analyse factors influencing tracheostomy deccanulation duration in oral and oropharyngeal carcinoma patients undergoing surgery. The study evaluates the impact of patient demographics, tumor characteristics, surgical resections, and postoperative complication on tracheostomy management and decannulation outcomes.A retrospective observational study analyzing tracheostomy decannulation in oral and oropharyngeal carcinoma patients. The study was conducted at Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC), Varanasi, Uttar Pradesh, India, a high-volume oncology center specializing in head and neck cancer treatment. A total of 90 oral and oropharyngeal carcinoma patients who underwent surgery with intraoperative tracheostomy between January 1, 2023, and December 31, 2023, were retrospectively analysed. Patients were included if they had no prior oncologic treatment and had complete records documenting demographics, tumor characteristics, surgical details, tracheostomy management, and swallowing status. Mean, median, and statistical significance (p-value) were used for analysis. Tracheostomy decannulation duration varied significantly based on surgical resection type ( p < 0.000 for tongue resection; p = 0.013 for maxillary reconstruction) and patient comorbidities. Flap failure, delayed wound healing, and bulky reconstruction contributed to longer decannulation times. Patients undergoing midline/lateral mandibulectomies had shorter decannulation times, while tongue base resection required prolonged airway management. No significant differences were found based on age. This manuscript has not been presented at any conference or meeting.

In patients with acquired maxillary defects, obturators are often effective, but some fail, necessitating further surgery, typically via free flap reconstruction. Long-term functional outcomes in these cases are underreported. This study examines the outcomes of secondary free flap reconstruction in patients who failed obturator use, focusing on enteral and tracheostomy tube dependence, dental implantation rates, and complications. This retrospective cohort study included patients who were initially planned for maxillary reconstruction with an obturator but were unable to retain it due to mechanical issues, not financial constraints. Seventy-one patients were included. There were no flap losses. Postoperatively, 98.6% (70 patients) underwent tracheostomy decannulation, 90.1% (64 patients) tolerated an oral diet, and 49.3% (35 patients) received successful dental implants. Postoperative complications occurred in 11.3% (8 patients). Secondary free flap reconstruction yields favorable outcomes in patients with failed obturators, improving tracheostomy dependence, diet tolerance, and dental implantation success. Financial considerations may influence flap choice.

Dental rehabilitation is considered challenging to achieve whenever composite scapulo-dorsal free flaps are used to reconstruct medium-to-large maxillary defects due to the fact that bone quality and quantity may be low, which may preclude placement of conventional dental implants. In such cases, current options for dental rehabilitation include printed patient-specific subperiosteal implants or zygomatic implants. The authors report three cases of maxillary tumour resections that led to medium-to-large defects reconstructed using composite scapulo-dorsal free flaps. Secondary zygomatic implants were perforated through the composite scapulo-dorsal flap more than 12 months after primary reconstruction. Initial loading with removable dental prostheses took place at the time of zygomatic implant placement, followed by secondary non-removable prosthesis placement. Adequate dental rehabilitation was achieved in all three cases, with an implant survival rate of 100% and no apparent complications after a follow-up period of more than 24 months. The technique described in the present paper shows promising results in achieving adequate dental rehabilitation in cases with composite scapulo-dorsal free flaps for reconstruction of medium-to-large maxillary defects and could be used as part of the dental rehabilitation strategy, especially in cases where dental prostheses have failed or removable prostheses cannot be used. The authors declare there are no conflicts of interest relating to this study.

Feasibility analysis of the iliac tubercle in repairing maxillary canine region defects.

An analysis of all possible lip defects and a comparison of outcomes following various reconstructive techniques is lacking in the literature. An analysis of lip reconstructions following cancer resection from 1994 to 2024 was performed. A total of 221 patients underwent lip reconstruction. Tobacco use (p = 0.003), diabetes mellitus (p = 0.042), and concurrent mandible or maxillary reconstruction (p = 0.019) were associated with surgical complications. Recurrent disease (p = 0.011) and oral commissure resection (p = 0.020) were associated with oral incompetence. Tobacco use (p = 0.001) and defects involving both upper and lower lips (p = 0.001) were associated with microstomia. Defects > 50% of the lip had higher rates of oral incompetence (p = 0.001) and microstomia (p = 0.035). Lip reconstruction outcomes are affected by patient-related factors, defect characteristics, and reconstructive techniques. Oral commissure resection, extensive lip defects, and lip defects in combination with mandibulectomy and maxillectomy are most prone to adverse outcomes, and we use our results to propose a comprehensive treatment algorithm.

Branched-chain amino acids promote gelatinase secretion from human periodontal ligament stem cells through nuclear factor kappa-B signaling.

Combined latissimus dorsi myocutaneous flap and 3D-printed PEEK implant for reconstruction of a large full-thickness chest wall defect: A retrospective study.

Three-Dimensional Morphological Changes in the Upper Airway After Maxillary Reconstruction with an Anterolateral Thigh Flap