Prevention points for plate exposure in the mandibular reconstruction

Onoda, Shigeki; Kimata, Yoshihiro; Yamada, Kiyoshi; Sugiyama, Narushi; Onoda, Tomoo; Eguchi, Mika; Mizukawa, Nobuyoshi

doi:10.1016/j.jcms.2012.01.013

Cited by 39 publications

(26 citation statements)

References 27 publications

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“…Furthermore, with larger soft tissue defects, osseocutaneous flaps may not have adequate associated soft tissue components, and two free tissue transfers may be required to optimize the reconstruction, adding to both surgical time and complexity [41]. Whichever reconstruction method is chosen, if insufficient bone and soft tissue were used to reconstruct the defect, wound contracture and steady pressure of the plate against the skin may lead to eventual plate exposure [14]. In one study, over-reconstructing medial soft tissue aspects and obliterating dead space resulted in a reduction of plate exposures from 38 to 8% even in patients reconstructed with lateral defects with a plate and soft tissue [41].…”

Section: Discussionmentioning

confidence: 99%

Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure

Yao

Ziai

Tsang

et al. 2017

J of Otolaryngol - Head & Neck Surg

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BackgroundPlate-related complications following head and neck cancer ablation and reconstruction remains a challenging problem often requiring further management and reconstructive surgeries. We aim to identify an association between surgical site infections (SSI) and plate exposure.MethodsA retrospective study between 1997 and 2014 was performed to study the association between postoperative SSI and plate exposures. Eligible patients included those with a history of oral squamous cell carcinoma who underwent surgical resection, neck dissection, and free tissue reconstruction. Demographic and treatment related information was collected. SSI were classified based on CDC definition and previously published literature. Univariable analysis on demographic factors, smoking history, diabetes, radiation, surgical and hardware related factors; while multivariable analysis on SSI, plate height, segmental mandibulectomy defects and radiation were conducted such as using cox proportional hazard models.ResultsThree hundred sixty-five patients were identified and included in our study. The mean age of the study group was 59.2 (+/−13.8), with a predominance of male patients (61.9%). 10.7% of our patient cohort had diabetes, and another 63.8% had post-operative radiation therapy. Patients with SSI were more likely to have plate exposure (25 vs. 6.4%, p <0.001). Post-operative SSI, mandibulectomy defects, and plate profile/thickness were associated with plate exposure on univariable analysis (OR = 5.72, p < 0.001; OR = 2.56, p = 0.014; OR = 1.44, p = 0.003 respectively) and multivariable analysis (OR = 5.13, p < 0.001; OR = 1.36, p = 0.017; OR = 2.58, p = 0.02 respectively).ConclusionSurgical site infections are associated with higher rates of plate exposure. Plate exposure may require multiple procedures to manage and occasionally free flap reconstruction.

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Section: Discussionmentioning

confidence: 99%

Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure

Yao

Ziai

Tsang

et al. 2017

J of Otolaryngol - Head & Neck Surg

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“…The number of patients who underwent reconstruction of the mandible with reconstruction plates was 12 in group A and six in group B, but few patients experienced plate exposure because we used various techniques to prevent plate exposure. In addition, no significant difference related to radiation exposure was apparent . However, one patient displayed no problems in the early postoperative period but experienced intraoral plate exposure postoperatively following the addition of radiation therapy.…”

Section: Discussionmentioning

confidence: 90%

“…In addition, no significant difference related to radiation exposure was apparent. 36 However, one patient displayed no problems in the early postoperative period but experienced intraoral plate exposure postoperatively following the addition of radiation therapy. An association between radiation exposure and plate exposure was thus suggested.…”

Section: Discussionmentioning

confidence: 93%

Effects of radiation therapy on postoperative complications and adverse events in patients with head and neck reconstruction with flaps

et al. 2014

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“…The most important point of reconstruction with a mandibular plate is to fill the dead space beneath the plate with tissue from the transferred flap. [5] CONCLUSION Mandibular reconstruction remains a challenging task for the head-and-neck reconstructive surgeon. Numerous factors, including the defect size, location of the defect, and presence of wound healing compromising conditions, must be judiciously reviewed and considered to prevent plate-related complications.…”

Section: Selecting An Appropriate Flap To Be Used With a Platementioning

confidence: 99%

“…[3] However, the use of reconstruction plates for mandibular reconstruction is often criticized because reported rates of post-operative plate exposures have been extremely high such as the 46.15% reported by Wei et al [4] Exposure is the C A S E R E P O R T most serious complication of plate reconstruction and necessitates a fundamental review of the therapeutic plan, including plate removal. [5] The present case report discusses the complication of an infected plate following a major head-and-neck surgery and a review of literature of titanium plate reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Titanium Reconstruction Plate Exposure Following Mandibular Reconstruction in Malignancy – A Case Report and Review of Literature

athota

Gadipelly

Batchu

et al. 2018

IJDA

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Mandibular reconstruction with titanium reconstruction plate is modality whose main advantage lies in its cost effectiveness and lack of secondary morbidity. It is thus still in widespread use, in spite of the availability of large number of other more successful reconstructive options. However, it is also associated with large number of complications. Plate exposure is not an uncommon complication, necessitating plate removal. A case of carcinoma of the anterior alveolus of the mandible is treated with supraomohyoid neck dissection, and segmental resection of mandible on the left side, followed by reconstruction of the mandible with titanium reconstruction plate and nasolabial flap. Patient developed infection in surgical site and exposure of titanium reconstruction plate on 20 th post-operative day. Subsequently, the reconstruction plate was removed under general anesthesia, and infection was treated with antibiotics based on culture and sensitivity. Post-operative recovery following plate removal was uneventful. The present case report discusses the complication of an infected plate following a major head-and-neck surgery and a review of literature of titanium plate reconstruction.

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Prevention points for plate exposure in the mandibular reconstruction

Cited by 39 publications

References 27 publications

Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure

Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure

Effects of radiation therapy on postoperative complications and adverse events in patients with head and neck reconstruction with flaps

Titanium Reconstruction Plate Exposure Following Mandibular Reconstruction in Malignancy – A Case Report and Review of Literature

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