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e-TMJ replacement: Clinical analysis27910flap. The authors focused on complications and concluded that “free vascularized grafts, specifically fibula, appear to be the option with the lowest surgical complication rate and good function that must be weighed against donor-site morbidity in high-risk cases.” However, additive manufacturing was not yet an option between 2001 and 2012, when that study was conducted. Our indications for surgery differed from those in the Bredell et al.(6) study, and we consider autologous reconstruction to be a second-choice option when dealing with nonmalignant tumors or other conditions. In addition to the advantage of more anatomically accurate reconstruction of the mandible with alloplastic eTMJR, the durations of both surgery and hospital stay are shorter with alloplastic reconstruction than with free vascularized grafts. Although the costs of materials may be relatively high with alloplastic eTMJR, the shorter durations not only lower morbidity risks but also reduce total costs, compared to autologous treatment options.(7,8) Furthermore, graft resorption, fracturing, malunion, nonvascularization, and donor-site morbidity are all potential complications of autologous flaps, which have not been observed with eTMJR.(9,10) A literature research conducted by Kearns et al.(11) evaluated donor-site morbidity according to patient-reported outcomes and showed that all frequently used autologous flaps, except the scapular flap, are susceptible to chronic pain, scarring, and sensory abnormalities at the donor site. Furthermore, during the early postoperative period after a free vascularized graft, surgeons often opt for intermaxillary fixation to improve the likelihood of flap healing, but this reduces total joint mobility, and thereby increased the risk of (recurrent) ankylosis. In contrast, eTMJR permits early mobilization, which has been shown to improve functional outcomes, when compared with immobilization after surgery.(12,13)When comparing outcomes between eTMJR and autologous reconstruction, an objective measure of functionality is required. This can involve evaluating parameters such as maximal mouth opening or lateral excursion, as well as postoperative pain and dietary function. These data are readily available for alloplastic TMJ reconstruction but not for autologous reconstruction of the TMJ and mandible. Saeed et al.(13) compared 49 patients who underwent autologous treatment with a costochondral graft with 50 patients who underwent TMJR. Patients Nikolas de Meurechy NW.indd 279 05-06-2024 10:15