['The reconstruction of large facial bony defects using microvascular transplants requires extensive surgery to achieve full rehabilitation of form and function. The purpose of this study is to measure the agreement between virtual plans and the actual results of maxillofacial reconstruction.', 'This retrospective cohort study included 30 subjects receiving maxillofacial reconstruction with a preoperative virtual planning. Parameters including defect size, position, angle and volume of the transplanted segments were compared between the virtual plan and the real outcome using paired t test.', 'A total of 63 bone segments were transplanted. The mean differences between the virtual planning and the postoperative situation were for the defect sizes 1.17 mm (95 % confidence interval (CI) (-.21 to 2.56 mm); p\u2009=\u20090.094), for the resection planes 1.69 mm (95 % CI (1.26-2.11); p\u2009=\u20090.033) and 10.16° (95 % CI (8.36°-11.96°); p\u2009<\u20090.001) and for the planes of the donor segments 10.81° (95 % CI (9.44°-12.17°); p\u2009<\u20090.001) The orientation of the segments differed by 6.68° (95 % CI (5.7°-7.66°); p\u2009<\u20090.001) from the virtual plan; the length of the segments differed by -0.12 mm (95 % CI (0.89-0.65 mm); not significant (n.s.)), respectively, while the volume differed by 73.3 % (95 % CI (69.4-77.6 %); p\u2009<\u20090.001). The distance between the transplanted segments and the remaining bone was 1.49 mm (95 % CI (1.24-1.74); p\u2009<\u20090.001) and between the segments 1.49 mm (95 % CI (1.16-1.81); p\u2009<\u20090.001).'] Does virtual planning of complex head and neck reconstruction result in satisfactory match between real outcomes and virtual models?