## 2 Materials and Methods
### Operation Technique  
The 3D printed stereolithographic model generated via virtual planning workflow as discussed above was used as template for accurate bending of commercially available reconstruction plate into individualized shape. The scar from previous surgery was used for access, that was extended bilaterally to have adequate exposure of the remaining right and left mandibular segments. Subperiosteal dissection was then carried out to release fibrous adhesions around the displaced mandibular segment. Coronoidectomy was routinely performed to release temporalis contracture. Additionally, expansion of posterior pocket of ramus and removal of fibrotic tissues around bone were required to freely mobilize the remaining bone segments. Usually, after the contracture release, the mouth opening could be increased from around 10 mm to 45-50 mm (Figure 6A,B and Figure 7A,E).  
The individualized pre-bent reconstruction plate was then fixed to bilateral residual segments to restore the contour of original mandible. In order to precisely position the reconstruction plate as in 3D printed model, the following steps were adopted depending upon the dental status. In patients with enough teeth for occlusal guidance, the preoperative maxillary and mandibular model were printed out to fabricate the occlusal splint for intraoperative guidance. During surgery, the residual mandible segment was resected until bleeding from the bone margin was seen. The final resection margin was then marked in the 3D printed mandible model by measuring the distance from angle or mandibular notch of residual mandible (Figure 6C,E and Figure 7D). Now, the pre-bent reconstruction plate was placed in the model along the inferior and posterior borders, and at least three screw holes were marked on each residual mandibular segment. The center of these holes to the bone resection margin was measured with a ruler on the model and subsequently marked in the real mandibular segment. The occlusal splint with intermaximillary wiring was  
Figure 6: Pre-bent individualized plates adaptation in dedutulous patients. (**A,B**) Mouth opening before and after coronoidectomy and contracture release. (**C,E**) Marking of resection margins on the model as per intraoperative scenario, taking linear measurements from mandibular angle or mandibular notch as a reference (Red line). (**D**) Pre-bent reconstruction plate fixed to the residual mandibular segments with the guidance of marked holes placed with reference from the model.  
additionally used for precise placement of pre-bent reconstruction plate in this category (Figure 7B,C). For edentulous patients, the pre-bent reconstruction plate was fixed to the residual mandible segment with the guidance of the marked center of three holes (Figure 6D).  
The fibular osseeospectocutaneous flap was harvested at the same time during the trismus release and mandible contour restoration by individualized reconstruction plate. The fibula was osteotomized by the ruler template method with at least 3 cm in each segment to ensure adequate bone perfusion [12]. Fine burring was carried out to make sure tight contact existed between resected mandibular margin and fibula osteotomy site so that proper bone healing was ensured.