Predictors of plate extrusion in oromandibular free flap reconstruction

Prasad, J.S. Rajendra; Sahovaler, Axel; Theurer, Julie; Yeh, David H.; Fung, Kevin; MacNeil, Danielle; Yoo, John; Nichols, Anthony C.

doi:10.1002/micr.30349

Cited by 19 publications

(29 citation statements)

References 36 publications

(66 reference statements)

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“…Oromandibular reconstruction is well-established, and the scapula, fibula, and radial forearm are workhorse osseous flaps that provide good form and function for speech, swallowing, mastication, aesthetics, and oral competence. 1 Over the last decade, there have been various studies 12,16,17,[20][21][22] that have identified common postoperative complications and potential predictors of these complications following oromandibular reconstruction with the goal of optimizing surgical outcomes. It is known that early and late complications after oromandibular reconstruction are common.…”

Section: Discussionmentioning

confidence: 99%

A Comprehensive Analysis of Complications of Free Flaps for Oromandibular Reconstruction

et al. 2021

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Objectives/Hypothesis To determine the frequency and management of short‐ and long‐term complications related to oromandibular free flap reconstruction and identify potentially predictive factors of hardware complications. Study Design Retrospective chart review. Methods A retrospective database from chart review was formed consisting of 266 oromandibular free flap reconstructions performed at a single institution over a 15‐year period. Data were collected on demographics, surgical treatment, complications, and management of complications. Subgroup univariate and multivariate analyses were performed to compare patients with hardware complications and those without. Results Eighty‐one of 266 patients (30.5%) that underwent oromandibular reconstruction had an early complication (<4 weeks after surgery), and the most common complications were cervical wound dehiscence (11.3%) and fistulas (9.40%). Eighty of 266 patients (30.1%) had a long‐term complication (>4 weeks after surgery) and the most common complication was plate exposure (26.7%). Univariate and multivariate analyses showed no association between whether there was hardware extrusion and fibula versus scapula, smoking history, virtual surgical planning (VSP), and dental implantation (P > .05). Only early complications (OR, 3.59, 95% CI, 1.83–7.05, P < .01) and patients undergoing oromandibular reconstruction for osteoradionecrosis (OR, 2.26, 95% CI, 1.10–4.64, P = .03) were strongly and independently associated with subsequent hardware extrusion on univariate analysis. Conclusions Both short‐ and long‐term complications are common after oromandibular reconstruction. The most important predictive factor for a late complication is an early complication and prior radiation. There was no difference of plate complications among the various free flap types. Dental implantation and use of VSP were not associated with hardware complications. Level of Evidence 4 Laryngoscope, 131:1997–2005, 2021

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Section: Discussionmentioning

confidence: 99%

A Comprehensive Analysis of Complications of Free Flaps for Oromandibular Reconstruction

et al. 2021

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“…Thus, our clinical outcome was comparable with previous reports (Arden et al, ; Fanzio et al, ; Maurer et al, ; Okura et al, ). In various studies, many predictive factors have been presented, and physical factors (Fanzio et al, ; Maurer et al, ; van der Rijt et al, ; Wood et al, ), hardware factors (Arden et al, ; Ettl et al, ; Mariani et al, ; Okura et al, ; Poli et al, ; Prasad et al, ; Shibahara et al, ), and treatment factors (Okura et al, ; Ryu et al, ; Shibahara et al, ; Wang et al, ) have been reported. Among these factors, plate length and the location of a mandibular defect influenced the prognosis of plate survival.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review and meta-analysis (Sadr-Eshkevari et al, 2013) demonstrated that the failure rate was 30.8% at the 32-month follow-up and discussed the risk factors of reconstruction plate failure from various viewpoints. Many reports discuss the influencing factors for reconstruction plate survival and list many factors such as physical factors such as whether an individual has diabetes mellitus (van der Rijt et al, 2015), smoking habit (Maurer et al, 2010;van der Rijt et al, 2015), whether an individual has had a blood transfusion (Fanzio et al, 2015), and surgical infection site (Wood, Shinn, Amin, Rohde, & Sinard, 2018), hardware factors such as plate length and location of a mandibular defect (Arden, Rachel, Marks, & Dang, 1999;Ettl et al, 2010;Mariani, Kowalski, & Magrin, 2006;Okura, Isomura, Iida, & Kogo, 2005;Poli, Ferrari, Bianchi, & Sesenna, 2003;Prasad et al, 2018;Shibahara, Noma, Furuya, & Takaki, 2002), and treatment factors such as radiation therapy and chemotherapy (Okura et al, 2005;Ryu et al, 1995;Shibahara et al, 2002;Wang, Zhang, & Mendenhall, 2005). Most reports have focused on the shape of the mandibular bone defect after resection and hardware-related complications; however, few reports have analyzed risk factors for plate failure from the viewpoint of dental occlusion (i.e., the mechanical force exerted on the reconstructed mandible and plate).…”

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confidence: 99%

A small number of residual teeth after the mandibular resection of oral cancer is associated with titanium reconstruction plate exposure

Hirohata

Yanagawa

Takaoka

et al. 2019

Clinical & Exp Dental Res

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ObjectiveReconstruction plates are used to treat patients with a segmental mandibular defect after oral cancer surgery. Reconstruction plate failure analysis has rarely focused on occlusion, which conducts a mechanical force to the mandible and the plate. To determine the prognostic factors, we retrospectively evaluated patients who underwent reconstruction of a mandibular segmental defect with a reconstruction plate and assessed the number of residual paired teeth.Material and MethodsFrom among 390 patients with oral cancer who visited University of Tsukuba Hospital (Tsukuba, Japan) between 2007 and 2017, we selected and analyzed the data of 37 patients who underwent segmental resection of the mandible and reconstruction with reconstruction plates. Prognostic factors evaluated were patient age, sex, TNM classification, plate manufacturer, treatment with radiotherapy or chemotherapy, whether the patient had diabetes or smoked, and whether the patient had a small number of residual paired teeth, plate length, and use of a fibular‐free flap. Among these 37 patients, eight reconstruction plates had intraoral or extraoral exposure and were removed in 5 years.ResultsKaplan–Meier and log‐rank analyses revealed that the prognosis for the 5‐year plate exposure‐free rate was significantly poorer for patients with a small number of residual teeth than for patients with no teeth or those with a large number of residual teeth (.01). Univariate Cox regression analysis revealed that a small number of residual teeth was a significant prognostic factor in the loss of a reconstruction plate (hazard ratio: 5.63; 95% confidence interval [1.10, 25.85]; .04).ConclusionsA small number of residual teeth after the segmental resection of oral cancer is significantly involved in reconstruction plate survival and may be important in predicting reconstruction plate prognosis.

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“…Variables previously demonstrated to be associated with hardware complications were considered for inclusion in the multivariable logistic regression model for each outcome. For plate exposure, these included age, smoking, radiation therapy, plate profile height, classification of defect, flap type, and surgical site infection 2,3,7,10,15 . For the composite outcome, these included age, smoking, diabetes, radiation therapy, plate profile height, classification of defect, flap type, and surgical site infection 2,3,7,10,15 .…”

Section: Methodsmentioning

confidence: 99%

“…Reconstruction hardware can be associated with complications including infection, plate exposure, plate fractures, and screw loosening. The rates of hardware‐related complications are variably reported (3%–45%) and may require prolonged treatment with antibiotic therapy and occasionally revision surgery to remove or replace the hardware 2–13 …”

Section: Introductionmentioning

confidence: 99%

Association of Plate Contouring With Hardware Complications Following Mandibular Reconstruction

et al. 2021

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Objectives/Hypothesis Despite considerable effort being dedicated to contouring reconstruction plates, there remains limited evidence demonstrating an association between contour and reconstructive outcomes. We sought to evaluate whether optimizing mandibular reconstruction plate contouring is associated with reduced postoperative hardware complications. Study Design Retrospective cohort study. Methods A cohort study was performed with adult patients (age ≥18 years) who underwent mandibulectomy and osseous free flap reconstruction following oncologic ablation at the University Health Network in Toronto, Canada, between January 1, 2003 and December 31, 2014. Patients with computed tomography scans performed within 1 year of reconstruction were included. Computer‐based three‐dimensional models were generated and used to calculate the mean plate‐to‐bone gap (mm). The primary outcome was plate exposure. Secondary outcome included a composite of plate exposure or intraoral dehiscence. Logistic regression models were fitted for each outcome accounting for other patient and surgical characteristics associated with the primary outcome. Results Ninety‐four patients met inclusion criteria, with a mean age of 60.4 (standard deviation [SD] 14.9). The mean follow‐up time was 31.4 months (range 3–94). Reconstruction was performed with fibular (57%) and scapular free flaps (43%). In the multivariable model, small mean plate‐to‐bone gap (<1 mm) was independently associated with 86% reduced odds of plate exposure (odds ratio [OR] 0.12; 95% confidence interval [CI] 0.02–0.55). Mean plate‐to‐bone gap less than 1 mm was also independently associated with reduced odds of developing a composite of plate exposure or intraoral dehiscence (OR, 0.29; 95%CI, 0.11–0.75). Conclusion Optimizing plate contouring during mandibular reconstruction may decrease the development of postoperative hardware complications. Level of Evidence 4 Laryngoscope, 132:61–66, 2022

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Predictors of plate extrusion in oromandibular free flap reconstruction

Cited by 19 publications

References 36 publications

A Comprehensive Analysis of Complications of Free Flaps for Oromandibular Reconstruction

A Comprehensive Analysis of Complications of Free Flaps for Oromandibular Reconstruction

A small number of residual teeth after the mandibular resection of oral cancer is associated with titanium reconstruction plate exposure

Association of Plate Contouring With Hardware Complications Following Mandibular Reconstruction

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