Risk Factors and Surgical Refinements of Postresective Mandibular Reconstruction: A Retrospective Study

Abstract

Background. Postresective mandibular reconstruction is common in cases of oral and mandibular tumors. However, complications such as infection, plate exposure, or plate fracture can occur. We identified several significant risk factors of complications after reconstructive surgery and compared the effectiveness of different surgical techniques for reducing the incidence of complications. Methods. This study is a retrospective analysis of 28 oromandibular cancer cases that required reconstructive surgery between January 1999 and December 2011 at Kobe University Graduate School of Medicine in Japan. All cases were classified using Hashikawa's CAT and Eichner's classification methods. Then, we determined whether these classifications and different treatment or surgical methods were significantly related to complications. Results. Complications after mandibular reconstruction occurred in 10/28 patients (36%). Specifically, five patients had plate fractures, four had plate exposures, and one had an infection. Radiation therapy and closure without any flaps were significantly related to infection or plate exposure. The wrap-around technique of securing reconstruction plates was used in 14 cases, whereas the run-through technique was used in two cases. Conclusions. The success of mandibular reconstruction depends on both mechanical and biological factors, such as the location of defects, presence of occlusions, and the amount of vascularization of the flap.

Microsurgical mandibular reconstruction using a resin surgical guide combined with a metal reconstructive plate

“…In our technique, osteotomy was performed manually. In maintaining the mandibular contour, it is crucial to retain the original positions of the condyle, angle, and tubercle (Hashikawa, Yokoo, & Tahara, ; Sakakibara et al, ). In our technique, the lateral cortices of the mandibular bodies of the 3D models were trimmed straight, followed by pre‐bending of the reconstructive plate.…”

“…It is imperative that surgical guides are prepared as quickly as possible to minimize the risk of the tumor changing size during the preparation process (Sakakibara et al, ). The main purpose of the treatment is to totally remove the tumor.…”

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

“…Concerning mechanical stresses, Shibahara et al (11) have reported that plate fractures due to mechanical stress occurred in eight of 110 patients who underwent reconstruction after resection of the mandibular angle. Furthermore, Boyd et al (20) have shown that bite force affected both the mechanical stress on reconstruction plates and the success rate of reconstructive surgery.…”

“…Furthermore, Boyd et al (20) have shown that bite force affected both the mechanical stress on reconstruction plates and the success rate of reconstructive surgery. Sakakibara et al (11) reported that mandibular angle defects and B2+B3+B4 occlusions are significantly related to plate fractures, and suggested that these fractures may be due to bite force or mechanical limitations of reconstruction plates. In our present study, using the CAT classification, the cases of plate fracture were one of AT type and the other of T type, and the case of screw fracture was AT type.…”

“…Moreover, when donor bone cannot be harvested or the patient's prognosis is poor, bone reconstruction may not be possible. In such cases, reconstruction plates can be used (11).…”