The utility of patient-specific surgical plates in free flap mandibular reconstruction: A systematic review and meta-analysis

To evaluate the accuracy and clinical outcomes using patient-specific surgical plates (PSSPs) in mandibular reconstruction. MEDLINE, EMBASE, Scopus, and Web of Science were searched. Study, patient, PSSP characteristics, and clinical outcomes from eligible studies were extracted using a standardized form. The risk of bias was assessed using the Cochrane Risk of Bias tool. Statistical significance for descriptive variables was evaluated using a t-test and chi-square tests. Common and random effects models were used for the meta-analysis. Inter-study heterogeneity was tested using the I2 test. Our search strategy yielded 1238 records, 12 of which met our eligibility criteria. Overall, the included studies provided a pooled participant size of 585 patients, of which 260 were in the intervention group, and 325 were in the control group. In our meta-analysis, PSSPs were associated with significantly lower intercondylar distance deviation (MD -2.15, 95% CI: -2.81 to -1.49) and intergonial distance deviation (MD -3.62, 95% CI: -6.77 to -0.47). However, the intercondylar angle deviation did not differ between PSSPs and controls. In addition, PSSPs may lead to shorter operative times (MD -77.18 min, 95% CI: -101.99 to -52.36) without significant differences in the length of hospital stay or the rates of postoperative complications. Our results indicate that PSSPs have the potential to improve clinical outcomes in mandibular reconstruction, particularly in reducing operative times and improving reconstruction accuracy. However, moderate-to-high heterogeneity and a high risk of bias underscore the need for further research, especially randomized controlled trials, for a more robust analysis.