## 4 Discussion
The mean differences in intercondylar distance, intergonal angle distance, anteroposterior distance, gonial angle, and duration of ischemia were all improved in the computer assisted group as compared with the conventional surgery group [28]. The accuracy measurements in category I and II in present study are in line with the findings in studies discussed. Although the accuracy, precision and reduced operative time has been attraction of computer-assisted planning in head and neck reconstruction, the technique is not without limitations. [PERSON] et al. in their study on computer-assisted surgery for segmental mandibular reconstruction stated that the location of osteotomy site and the design of skin paddle might change on the table and differ from virtual plan since the status of surgical margins is important, the precise determination of which is not always possible from imaging [10; 29]. Even if it is true that the extent of the lesion can be visualized on the three-dimensional model to determine resection sites, it might only be possible for tumors and not for cases of osteoradinecrosis, in which bone quality assessed clinically usually determines resection margins [29]. [PERSON] et al. in their multicenter study reported that insufficient guide design or inaccurate guide fits will inevitably lead to intraoperative difficulties in positioning the guides and thus to reconstruction inaccuracies [19]. Thus, the importance of flexibility during surgery cannot be overlooked and an approach that welcomes surgical flexibility and provides accurate reconstruction at the same time would serve beneficial in such scenarios. The facts and findings from the studies discussed above justifies the technique of patient specific manual plate bending discussed in the present study. In a recent publication, issue has been raised regarding formation of biofilm in 3D printed customized titanium reconstruction plates and commercially available plates. 3D-printed plates showed higher roughness than commercial plates. All strains of bacteria colonized 3D- printed raw plates more densely than commercial plates. Although this finding supports use of factory manufactured stock plates, the obvious loss of anti-corrosive layer during plate bending and cutting happens to be a major drawback of commercial plates [26]. The approach discussed and the protocol devised is easy to follow and the cost of procedure is significantly reduced as compared to 3D printed patient specific implants. Although the patient-specific pre-bent plate via the template printing will not be able to catch up with the optimal accuracy offered by 3D printed patient-specific implant plus cutting, drilling and positioning guides, it definitely provides greater degree of surgical freedom in cases of osteoradinecrosis as well as good and acceptable accuracy for L/LC and LCL defect reconstruction, respectively. The retrospective nature of the study with limited sample size remains a major limitation. However, the protocol discussed does pave a way for organized prospective studies with larger samples in the future. Conceptualization, H.-T.L. ; methodology, C.-H.L. and H.-T.L. ; software, H.-T.L. and K.B. ; validation, H.-T.L., K.B. and C.-H.L. ; formal analysis, K.B. ; investigation, K.B. ; resources, C.-H.L. ; data curation, H.-T.L. ; writing--original draft preparation, K.B. ; writing--review and editing, H.-T.L. ; supervision, C.-H.L. and H.-T.L. All authors have read and agreed to the published version of the manuscript. This research received no external funding. The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Chang Gung Memorial Hospital, Taiwan (No.202100984B0) for studies involving humans. Patient consent was waived because no patient can be identified from the image. Data Availability Statement: The data presented in this study are available on request from the corresponding author.