Mandibular Reconstruction Reimagined: Are Osseous Flaps Truly Superior to Alloplastic Reconstructions?

Background Segmental mandibular defects require reconstruction to restore esthetics, oral function, and to prevent complications. While free vascularized bone grafts are widely regarded as the gold standard, alloplastic reconstruction using a bridging reconstruction plate covered by a soft tissue flap represents a valuable alternative. However, it remains unclear whether this approach is associated with higher postoperative complication rates, and comparative studies remain scarce. Methods This retrospective study compared postoperative outcomes between both techniques in 335 reconstructions of segmental mandibular defects operated over 8 years. The N-1 χ ² -test, Fisher’s exact test and Mann-Whitney-U test were used to test for statistical significance after mode and mean imputation were performed on independent variables with missing data. Results Patients who received alloplastic reconstructions were significantly older (74.4 ± 10.5 vs. 63.4 ± 10.6 years, p < 0.001) and had significantly more comorbidities including hypertension, atherosclerosis and prophylactic anticoagulation. This likely contributed to the higher mortality (24.3% vs. 10.1%, p = 0.011) and pneumonia rates (13.5% vs. 4.7%, p = 0.029). Nevertheless, postoperative complication rates did not increase, with plate exposure (21.6% vs. 24.8%, p = 0.669), fixation failure (5.4% vs. 6.0%, p = 0.878), and early flap loss (5.4% vs. 4.4%, p = 0.773) rates showing no significant differences compared to osseous flaps. Furthermore, alloplastic reconstructions had significantly shorter surgery times (8.4 ± 2.0 vs. 9.6 ± 2.2 h, p = 0.002) and fewer wound infections (13.5% vs. 30.9%, p = 0.028). Conclusions Our findings emphasize the value of alloplastic reconstruction as a pragmatic and effective option when osseous reconstruction is contraindicated and advocate for personalized treatment strategies.