Virtual Surgical Planning for Mandibular Reconstruction in Paget Disease With Severe Deformity

Paget disease of the mandible is a rare metabolic bone disorder characterized by abnormal bone remodeling, resulting in deformity and structural weakness. Medical therapy, including bisphosphonates, is the most common treatment; however, chronic osteomyelitis is a known complication of mandibular Paget disease, and definitive management with mandibular resection and reconstruction has rarely been reported. Mandibular reconstruction in such cases is particularly challenging because severe deformity obscures normal anatomical landmarks. Virtual surgical planning (VSP) and patient-specific reconstruction systems have been developed to improve surgical accuracy in complex maxillofacial reconstruction. However, their application in Paget disease with severe mandibular deformity has never been described. We report a case of mandibular resection and reconstruction using VSP in a patient with Paget disease of the mandible complicated by chronic osteomyelitis. Due to the absence of reliable anatomical reference, VSP was essential to determine resection margins and reconstruction geometry. Segmental mandibulectomy and free fibular flap reconstruction were performed according to the preoperative plan, resulting in satisfactory postoperative functional and aesthetic outcomes without recurrence of infection. This case suggests the potential utility of VSP for accurate and reliable mandibular reconstruction in Paget disease with severe deformity, where conventional techniques are limited.