Digital mandibular reconstruction design guided by condylar position

Mandibular defects following tumor resection can severely affect facial form, occlusal stability, and temporomandibular joint (TMJ) function. We developed a condyle-oriented digital workflow designed to optimize postoperative condylar position and improve functional reconstruction. Preoperative CT data were used to generate mirrored mandibular models based on the ideal condylar relationship, followed by fibular segment planning and the creation of a full set of patient-specific guides incorporating a shared screw-hole strategy for precise intraoperative alignment. Seventeen patients underwent reconstruction using this protocol and were evaluated through CT-based three-dimensional analyses, TMJ functional assessment, and the Research and Treatment of Cancer Head and Neck Cancer Quality of Life Questionnaire (EORTC QLQ-H&N35). Postoperative condylar position and mandibular morphology showed no significant differences compared with preoperative measurements, indicating high reconstruction accuracy. TMJ function was comparable to that reported for traditional occlusion-guided reconstruction, while EORTC QLQ-H&N35 scores demonstrated improvement in domains related to diet. These findings suggest that our condyle-oriented planning combined with a fully digitalized guide system can achieve accurate anatomic restoration and favorable functional rehabilitation in mandibular reconstruction.