A case of plate replacement using a modified technique of the resin frame method for reconstruction plate fracture after mandibulectomy

Abstract

We describe a new plate replacement method using a resin frame to reposition the mandible in the position before reconstruction plate fracture.The patient was an 89-year-old male who underwent segmental mandibulectomy, neck dissection, pectoralis major flap reconstruction, and plate reconstruction for left mandibular gingival carcinoma. Two years and eight months after the surgery, the reconstruction plate fractured. A full-scale three-dimensional model (3D model) was created to make a resin frame based on computed tomography taken before the fracture. Wire-holding grooves and screw holes were added to the resin frame to reduce the mandible in the position before the reconstruction plate fracture. After the fractured plate was exposed, the resin frame and fractured plate were ligated with a wire using wire-holding grooves.Subsequently, the resin frame was secured to the mandible with screws, and the position of the mandible was secured.After removing the fractured plate, a pre-bent reconstruction plate was secured in its place. With conventional methods, it is difficult to achieve an accurate position for the mandible during surgery ; however, in the present case, the 3D model created based on previous CT data and the positional relationship replicated by the resin frame allowed favorable reproduction of the original mandibular position. The present method is useful for cases such as the present one, where the number of remaining teeth is limited and maxillomandibular fixation is not indicated.