Clinical application of titanium plate reconstruction of mandibular defect: 10 years of follow up

Abstract

To summarize the postoperative complications of reconstruction of mandible defect with titanium reconstruction plate. A total of 111 cases of the mandibular defect caused by various reasons and repaired by titanium reconstruction plate in the Department Oral and Maxillofacial Surgery of the affiliated Hospital of Qingdao University from 2003 to 2012 were collected and followed up. The complications were analyzed. Thirty-seven percent of 111 cases showed long term complications. The titanium fracture was the main complication(16%[18/111]), followed by stress-shielding (9%[10/111]), infection(8%[9/111]), and titanium plate exposure(4%[4/111]). Titanium plate fracture occurred within 8 months and 3 years after surgery. The simple titanium plate reconstruction had the highest rate of plate fracture(30%[15/50]). Stress-shielding in non-vascularized bone graft was more significant than that in vascularized bone graft(P<0.05). When replaced by mini-titanium plate, the stress-shielding effect disappeared gradually. When the retention of mandibular margin height was less than 1 cm with the use of reconstruction plate, the postoperative complications were prone to occur. Bone graft is the best way to reconstruct mandibular defect, and simple reconstruction plate repair is applied only as a transitional means for high degree of malignancy, obvious recurrence tendency tumor or special reasons such as age etc, which are not suitable for bone graft. The reconstruction plate fixation is not recommended for bone graft, especially non-vascularized bone graft. The retention of mandibular margin with reconstruction plate fixation is open to discussion.