Clinical Study of Reconstruction Plates Used in the Surgery for Mandibular Discontinuity Defect

Abstract

Background/Aim: Postresective mandibular reconstruction is common in cases of oral and mandibular tumors. However, complications such as plate fracture and/or plate exposure can occur. The purpose of this study was to analyze complications and survival of reconstructive plates used to correct mandibular defects caused by oral cancer. Patients and Methods: Clinical and radiological data from 34 patients were analyzed. Only discontinuous mandibular defect cases were included in this study. All cases were classified using the Hashikawa's CAT and Eichner's classification methods. Then, we determined whether these classifications and clinical treatment methods were significantly related to complications. Results: Complications after mandibular reconstruction occurred in 10 of 34 patients, specifically, two plate fractures, one screw fracture, and seven plate exposures occurred. The plate fractures occurred 5 and 6 months after operation, and the screw fracture occurred 39 months after operation. Using the Hashikawa's CAT classification, the two cases of plate fracture were one of AT type and the other of T type, and the screw fracture was AT type. Using Eichner's classification, all three cases of plate and screw fractures were B2 type. Conclusion: We suggest that plate and screw fractures were caused by the type of mandibular defect and bite force.

Only a Plate? Nine-Year Follow-Up After Partial Mandibulectomy and Reconstruction With Titanium Plate

“…41 Generally, due to the complex nature of oncological surgery, involving bone, mucosa as well as muscle, with the preparations needed to minimize the risk of plate-related complications, extensive planning must be made before procedure. 34 With presenting this case, we argue that reconstruction plates could be considered when deciding the treatment method. While usage of plates for mandibular reconstruction has been criticized, 33 it might be better suited for certain patients because of its immediate availability, reduced surgery time and the lack of need for previous planning.…”

“…38 The risk of complications mainly appears to be tied to post-operative dentition, post-operative radiation therapy and dental rehabilitation. Close post-operative maintenance of the occlusal relationship and the surrounding tissues can decrease the risk for complications, 34,35 and the same appears to be true for customized plates when compared to the ready-made type. 40 Our presented case was closely monitored, and this strategy proved to work life-long.…”

“…The outcome of treatment can be more correctly assessed when considering these factors. 1,32 The use of reconstruction plates is associated with a high risk of plate-related fractures, plate exposure and screw fracture, [33][34][35] although plate exposure has been tied to both the type of soft tissue flap and radiotherapy. 36 Plate only reconstruction, lateral defects and post-operative dentition is strongly associated with plate fractures.…”

Complications of Reconstruction Plate Installation in Mandibular

“…However, until now complications related to the use of postoperative plates such as plate exposure, plate fracture, screw loss and infection sometimes still occur. 4 Complications of plate reconstruction that occur can be caused by many factors, namely age, systemic disease, oral malignancy, tissue tension during closure, thin soft tissue covering, postoperative radiotherapy and chemotherapy, extensive resection, tissue necrosis around the plate and allergies. [15][16][17] Allergic conditions can occur in the form of an immune reaction to metal particles released from the corrosion of metal.…”

“…Factors affecting initial remodeling of transplanted bone includes physiological pressure, quality of transplanted bone, stability of bone fixation, and condition of surrounding soft tissue are required for the success of transplantation. 4,5 Most mandibular reconstructive surgical procedure employs autogenous bone graft. The utilization of xanogeneic bone and allogeneic bone had also been performed effectively.…”