Quantification of the Bimodal Plate-Specific Complication Profile Associated With Reconstruction of Segmental Mandibular Defects With Reconstruction Plate and Soft Tissue Flap: Evidence From Systematic Review.

Abstract

Reconstruction of segmental mandibular defects with a mandibular reconstruction plate and separate soft tissue flap can be indicated in certain patients. Whilst this technique can provide acceptable results, its exact longevity and timing of associated complications is poorly understood. This study was designed to quantify and plot in time the complication profile associated with this technique of mandibular reconstruction.A search of the Medline and PubMed Central databases was conducted using the terms "Mandibulectomy" and "Reconstruction Plate." Articles reporting total number of plate extrusions and fractures and their postoperative timing were included.Nine articles were included, representing 265 patients with mandibulectomy defects reconstructed using mandibular reconstruction plates. Of these, 135 were male (62%) and 82 were female (38%). The mean age was 59 years. The predominant pathology was oral cavity Squamous Cell Carcinoma (SCC) (80%). Seventy-three patients (28%) experienced complications (mean follow-up: 24 months), with median time to complication of 3 months. Forty-three plate extrusions (16%), 20 plate fractures (8%) and 10 cases of loosened screws (4%) were reported. A bimodal temporal distribution of complications was found.Overall, a plate-specific complication rate of 28% was found, confirming a higher incidence of complications in comparison to osseous free flap reconstruction. These occur over a bimodal time distribution, with extrusion occurring earlier than fracture. interference with speech, swallow and dental rehabilitation, and delay of adjuvant therapy are potential consequences. These findings indicate that patients may be better served by more complex reconstructive procedures, to minimize exposure to a frequent and prolonged complication profile.