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Definitions of bony nonunion varied and were reported in 20 studies. Higher pooled rates of complete union were observed in reconstructions of the maxilla, reconstructions using the radius, and surgeries aided by virtual surgical planning. Treatment for nonunion was reported in 11 studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Virtual surgical planning has the potential to improve union outcomes and reduce the need for revision surgeries in nonunion cases. The heterogeneity of the studies necessitates randomized controlled trials for further analysis of the nonunion risk factors and consequences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70153","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T08:58:31Z","timestamp":1770800311000},"page":"1113-1129","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Bony Union in Maxilla and Mandible Free Flap Reconstruction: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4969-2824","authenticated-orcid":false,"given":"Khanh Linh","family":"Tran","sequence":"first","affiliation":[{"name":"Division of Otolaryngology, Department of Surgery, Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zora","family":"Heer","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology, Department of Surgery, Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8758-5990","authenticated-orcid":false,"given":"Harkaran Singh","family":"Dial","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology, Department of Surgery, Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2720-0075","authenticated-orcid":false,"given":"Cornelius","family":"K\u00fcrten","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology, Department of Surgery, Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Ma","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology, Department of Surgery, Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology, Department of Surgery, Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9596-3640","authenticated-orcid":false,"given":"Natalie","family":"Mezey","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology, Department of Surgery, Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masih","family":"Sarafan","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology, Department of Surgery, Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidney S.","family":"Fels","sequence":"additional","affiliation":[{"name":"Department of Electrical and Computer Engineering, Faculty of Applied Science University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3107-581X","authenticated-orcid":false,"given":"Antony J.","family":"Hodgson","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Faculty of Applied Science University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farahna","family":"Sabiq","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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