Use of reconstruction plate in surgical treatment of primary and secondary tumors of the mandible

Abstract

Introduction. Squamous cell carcinoma of the oral mucosa advances into the mandible in locally advanced tumors in 13–38 % of cases. Frequently, this situation requires inclusion of segmental resection of the mandible into the surgical plan. This approach requires adequate reconstruction for preservation of satisfactory functional and esthetic treatment results. Selection of reconstruction method remains an important clinical problem in everyday practice of a head and neck cancer specialist.Aim. To analyze clinical materials on the use of reconstruction plates in oncological practice, evaluate esthetic and functional results of their use in patients who underwent single-stage reconstruction after segmental resection of the mandible.Materials and methods. The results of treatment of 103 patients after segmental resection of the mandible with defect reconstruction using only a reconstruction plate or a reconstruction plate with a distant or free flap who were treated at the Loginov Moscow Clinical Scientific Center and N.N. Blokhin Scientific Medical Research Center of Oncology between 1998 and 2019 were analyzed.Results. Complications at various times (between 2 months and 3 years) were observed in 15 (14.6 %) patients. The most frequent complications were plate cutting through the skin and mucosa (6 (5.8 %) cases) and osteomyelitis of fragments of the mandible (7 (6.7 %) cases). In 2 (1.9 %) cases, plate fracture was observed. It is necessary to note that during anti-inflammatory treatment in 4 (3.9 %) patients, osteomyelitis was managed while 11 (10.7 %) patients required removal of the reconstruction plate. Per the data analysis, in patents with surgical defect in the anterior area (defects ТТ, АТТ, САТ per the J.S. Brown classification, 2016) complications are significantly more common (in 11 (23.9 %) of 46 cases) than in patients with limited defects of the body and condyle (defects АТ, АС) (in 4 (7.0 %) of 57 cases). The rate of complications is also significantly affected by radiation dose.Conclusion. Therefore, use of a plate for reconstruction of mandible defect is aesthetically and functionally acceptable reconstruction technique. Severe complications leading to plate removal are rare and were observed in 11 (10.7 %) patients.