Segmental Mandibular Defects Research Articles

Morphometric evaluation of bone regeneration in segmental mandibular bone defects filled with bovine bone xenografts in a split-mouth rabbit model

BackgroundBovine bone grafts have been widely used in dentistry for guided tissue regeneration and can support new bone formation in direct contact with the graft. The aim of this study was to compare the morphometric and bone density changes after using two different bovine bone graft blocks in segmental osseous defects in the mandible of rabbits following different postoperative periods.Material and methodsCritical size segmental defects were surgically created bilaterally in the jaw of 18 rabbits. The defects were filled with either deproteinized bovine bone mineral with 10% collagen (DBBM-C; BioOss Collagen®), lyophilized bovine medullary bone (LBMB; Orthogen®), or left untreated according to a split-mouth design. Animals were sacrificed after 3 or 6 months of healing. The hemimandibles were scanned ex vivo using a high-resolution (19 μm) microcomputed tomography. Morphometric and bone density parameters were calculated in the region of the defect using CT-Analyser (Bruker). Initial graft blocks were used as baseline.ResultsDBBM-C presented a denser microarchitecture, in comparison to LBMB at baseline. DBBM-C and LBMB grafted regions showed a similar progressive remodeling, with a significant decrease in structure complexity and maintenance of bone volume fraction during the postoperative follow-up periods. Both graft materials showed an enhanced bone replacement and more complex structure compared to untreated defects. The apparent fusion between the graft and host bone was observed only in the defects filled with LBMB.ConclusionLBMB grafts showed a similar behavior as DBBM-C regarding structural remodeling. In LBMB samples, apparent integration between the host bone and the graft was present.

Multidisciplinary approach for reconstruction of a large segmental mandibular defect following trauma with vascularized scapular flap, distraction osteogenesis and dental implants – Report of a case and review of the literature

Multidisciplinary approach for reconstruction of a large segmental mandibular defect following trauma with vascularized scapular flap, distraction osteogenesis and dental implants – Report of a case and review of the literature

Functional outcome predictors following mandibular reconstruction with osteocutaneous fibula free flaps: correlating early postoperative videofluoroscopic swallow studies with long-term clinical results

BackgroundAdvancements in the field of microvascular surgery and the widespread adoption of microvascular surgical techniques have made the use of osteocutaneous fibula free flaps the standard of care in the surgical management of segmental mandibular defects. Although the literature possesses abundant evidence to support the effectiveness of fibula free flaps as a reconstructive method, there are relatively few studies reporting on outcomes as objectively measured by videofluoroscopic swallowing studies (VFSS). The purpose of this study is to explore the potential correlation between early postoperative VFSS and the long-term swallowing outcomes in patients who underwent mandibular reconstruction with fibula free flaps.MethodsWe performed a retrospective chart review of 36 patients who underwent mandibular reconstruction with osteocutaneous fibular free flaps between 2009 and 2012. Demographics, clinical variables, VFSS data, and diet information were retrieved. Penetration and aspiration findings on VFSS, long-term oral feeding ability, and the need for gastrostomy tube were statistical endpoints correlated with postoperative clinical outcomes.ResultsThirty-six patients were reviewed (15 females and 21 males) with a mean age of 54 years (7–81). Seventeen cases were treated for malignancy. The size of the bony defect ranged from 3 to 15 cm (mean = 9 cm). The cutaneous paddle, a surrogate for soft tissue defect, ranged from 10 to 125 cm2 (mean = 52 cm2). A gastrostomy tube was present in patients preoperatively (n = 8), and postoperatively (n = 14). Seventeen patients had neoadjuvant exposure to radiation. Postoperative VFSS showed penetration in 13 cases (36%) and aspiration in seven (19%). Overall, 29 patients (80.6%) achieved unrestricted diet, and this was statistically correlated with age (p = 0.037), radiation therapy (p = 0.002), and preoperative gastrostomy tube (p = 0.03). The presence of penetration or aspiration on VFSS was a strong predictor for long-term unrestricted oral diet (p < 0.001).ConclusionEarly postoperative VFSS is an excellent predictor for long-term swallowing outcomes in patients undergoing mandibular reconstruction with osteocutaneous fibula free flaps.

Effects of computer aided design and manufacture for reconstruction of mandibular defect with vascularied iliac crest flap graft

Objective To evaluate the clinical application and effect of computerized digital surgical assisted design and manufacture for reconstruction of mandibular defect with vascularied iliac crest flap graft. Methods CT was used to scan the craniofacial and maxillofacial region of mandibular ameloblastoma patient, and then the 3D model of the maxillofacial skeleton was reconstructed using the computerized digital surgical aid design to simulate the focal resection and the mandibular defect reconstruction with the iliac crest flap. Surgical guides were prepared by 3D printing to assist focal resection and bone reshaping. Postoperatively, clinical and CT examinations were performed to observe the restoration of the patient＇s facial appearance and occlusal relationship, as well as wound healing and graft survival. Results Postoperative review results showed that the bone graft survived well, and the anastomosed bone was formed. The wound in the surgery area healed. No recurrence of the tumor was found after clinical and CT examination. The maxillofacial appearance was well restored, and the residual occlusal relationship recovered well. Conclusions The use of computerized digital surgical aided design combined with 3D printing technology can effectively simplify the mandibular segmental defect repair and reconstruction and optimize the postoperative repair effect. Key words: Image processing; Computer-aided design and manufacture; Ilium; Myocutaneous flap; Mandibular defect

A mass guide for the harvest of cortico-cancellous bone from the posterior iliac crest for mandibular reconstruction

This study sought to find the mass of particulate cortico-cancellous bone graft required per 1 cm continuity defect of the mandible. Harvested bone was weighed, milled and maximally compressed in a syringe. The defect length (DL) was measured in centimetres, and the compressed bone volume (CBV) used was recorded. The wet bone mass (WBM) of bone required per centimetre of mandibular defect, and the mass of bone yielding 1cc of compressed bone was calculated. Results were analysed statistically to determine if clinically meaningful differences exist between male and female iliac crest. Forty three patient records were reviewed (28 female). Thirty patients had bilateral, and 13 patients had unilateral iliac crest harvest. Mean WBM used per centimetre of mandible defect was 6.9 g.WBM required to produce 1cc of CBV was 2.0g. For the bilateral harvest group the mean DL was 10.3 cm, the mean WBM was 66.7 g, and the mean CBV was 33.9cc. There was no significant difference in mean WBM between male (72.8 g) and female (62 g) patients. The mean CBV for males (39.7 g) was significantly higher than females (29.5 g). For patients who had unilateral harvest the mean DL was 7.7 cm, the mean WBM harvested was 59.1 g, and the mean CBV was 29.4cc. The mean wet bone mass of posterior iliac crest required to graft each centimetre of mandibular segmental defect is 6.9 grams. A unilateral posterior iliac crest harvest will yield on average 59.1 grams of bone whilst a bilateral posterior iliac crest harvest will yield on average 66.7 grams

Immediate Reconstruction of Segmental Mandibular Defects with Non-Vascularized Bone Grafts

Purpose There is long-standing evidence that a segmental mandibular defect greater than 6cm needs to be reconstructed with a vascularized graft, which significantly increases patient morbidity. We challenge this notion. In this study, we determined maximum defect size that can be predictably reconstructed with nonvascularized bone grafts immediately after resection. Methods A retrospective chart review of 34 patients that had mandibular resections for benign pathologies that were immediately reconstructed with particulate marrow grafts were reviewed. The same senior surgeon at a university medical center oversaw all cases. Cohort demographic and descriptive data were obtained, resection size was determined, and statistics were calculated. Results The patient cohort had a mean age of 49 years (standard deviation [SD] = 12.2), and consisted of 16 males and 18 females. Mean follow-up time was 18 months. Diagnoses included 15 (44%) cases of osteomyelitis, 13 (38%) ameloblastomas, 5 (15%) ossifying fibromas, and 1 (3%) histiocytoma. Average resection size of all cases was 8.7 cm (SD = 4.1). Average resection size of successful grafts was 8.1 cm (SD = 3.2). Graft failures measured 12.1 cm (SD = 2.8). When comparing graft success versus failure there is statistical significance (P Conclusions Taken together, these data demonstrate that segmental mandibular resections for benign pathology can be predictably reconstructed using non-vascular grafts up to 8.1Â ± 3.1cm. The morbidity and time of surgery of particulate marrow grafts is significantly less compared with free-flap reconstruction. Furthermore, the course of treatment in these patients is significantly decreased. This facilitates expedited convalescent care and an earlier return to normal form and function.

A small number of residual teeth after the mandibular resection of oral cancer is associated with titanium reconstruction plate exposure.

ObjectiveReconstruction plates are used to treat patients with a segmental mandibular defect after oral cancer surgery. Reconstruction plate failure analysis has rarely focused on occlusion, which conducts a mechanical force to the mandible and the plate. To determine the prognostic factors, we retrospectively evaluated patients who underwent reconstruction of a mandibular segmental defect with a reconstruction plate and assessed the number of residual paired teeth.Material and MethodsFrom among 390 patients with oral cancer who visited University of Tsukuba Hospital (Tsukuba, Japan) between 2007 and 2017, we selected and analyzed the data of 37 patients who underwent segmental resection of the mandible and reconstruction with reconstruction plates. Prognostic factors evaluated were patient age, sex, TNM classification, plate manufacturer, treatment with radiotherapy or chemotherapy, whether the patient had diabetes or smoked, and whether the patient had a small number of residual paired teeth, plate length, and use of a fibular‐free flap. Among these 37 patients, eight reconstruction plates had intraoral or extraoral exposure and were removed in 5 years.ResultsKaplan–Meier and log‐rank analyses revealed that the prognosis for the 5‐year plate exposure‐free rate was significantly poorer for patients with a small number of residual teeth than for patients with no teeth or those with a large number of residual teeth (.01). Univariate Cox regression analysis revealed that a small number of residual teeth was a significant prognostic factor in the loss of a reconstruction plate (hazard ratio: 5.63; 95% confidence interval [1.10, 25.85]; .04).ConclusionsA small number of residual teeth after the segmental resection of oral cancer is significantly involved in reconstruction plate survival and may be important in predicting reconstruction plate prognosis.

Nonvascularized Bone Grafts for Reconstruction of Segmental Mandibular Defects: Is Length of Graft a Factor of Success?

The purpose of this study was to evaluate a long-debated question in the field of whether the success of reconstructing mandibular defects with nonvascularized bone grafts (NVBGs) is dependent on the length of the graft. The inclusion criteria were patients who had received NVBGs, such as anterior or posterior iliac crest and costochondral grafts, to reconstruct segmental defects of the mandible between 2008 and 2017 at the Department of Oral and Maxillofacial Surgery at Case Western Reserve University. Patients with a history of irradiation of the head and neck and patients with inadequate follow-up were excluded from this study. Data such as defect length, patient age, comorbidities, length of follow-up, location of defect, etiology of defect, and postoperative course were collected. Success was judged by radiographic and clinical evidence of bone continuity and stability at a minimum of 4months postoperatively. Failures were considered loss of all or part of the graft, resulting in a residual continuity defect requiring further bone grafting. We identified 61 potential cases, of which 29 met the inclusion and exclusion criteria. The mean age of the patients at the time of grafting was 55years (range, 17 to 81years), with a mean follow-up length of 18months. The length of defects ranged from 2 to 22cm. The grafts were 6cm or less in length in 7 defects and greater than 6cm in length in 22 defects. All cases were grafted at a minimum of 6months after resection, and bone morphogenetic protein was used in 25 cases (86%).Failure occurred in 1 patient in the group with grafts of 6cm or less and 2 patients in the group with grafts greater than 6cm, corresponding to success rates of 86% and 91%, respectively. Eight patients experienced minor complications such as wound dehiscence or infection, which resolved with local measures and antibiotics. The results of our study show that NVBGs are a viable, safe, and effective treatment option for segmental mandibular defects over 6cm in length in non-irradiated patients.

Biomechanical Assessment of Design Parameters on a Self-Developed 3D-Printed Titanium-Alloy Reconstruction/Prosthetic Implant for Mandibular Segmental Osteotomy Defect

Patients with oral cancer often have to undergo the surgery for mandibular excision. Once the bone in the cancerous area is removed, not only the facial area but also chewing function of the patient is needed to be repaired by clinicians. In recent years, the rapid growth of three-dimensional (3D) metal printing technology has meant that higher-quality facial reconstructions are now possible, which could even restore chewing function. This study developed 3D-printed titanium (Ti)-alloy reconstruction implant for a prosthesis designed for mandibular segmental osteotomy defects, and 3D finite element (FE) analysis was conducted to evaluate its biomechanical performance. The analyzed parameters in the FE models were as follows: (1) two prosthesis designs, namely a prosthesis retaining the residual mandibular bone (for patients with mild oral cancer) and a prosthesis with complete mandibular resection (for patients with severe oral cancer); (2) two lengths of prosthesis, namely 20 and 25 mm; and (3) three thicknesses of prosthesis, namely 0.8, 1, and 1.5 mm. A 45° lateral bite force (100 N) was applied to the top of the prosthesis as the loading condition. The results revealed that for the two prosthesis designs, the prosthesis retaining the residual mandibular bone showed higher stress on the prosthesis and cortical bone compared with the prosthesis with complete mandibular resection. Regarding the two prosthesis lengths, no fixed trend of prosthesis stress was found, but stress in the cortical bone was relatively high for a prosthesis length of 20 mm compared with that of 25 mm. For the three prosthesis thicknesses, as the thickness of the prosthesis decreased, the stress in the prosthesis decreased but the stress in the cortical bone increased. These findings require confirmation in future clinical investigations.

Reconstruction plate-related complications in mandibular continuity defects.

The purpose of this study was to evaluate the complications associated with the use of reconstruction plates with or without non-vascularized bone graft in reconstruction of mandibular segmental defects caused by trauma and tumor resection and to analyze various factors that are associated with the development of complications. A retrospective observational study was conducted, and the investigated variables included the age and gender of the patients, etiology of the defect, the site of the defect, the size of the defect, whether bone graft was used or not, type of plate used, and whether the reconstruction was immediate or delayed. The outcome variables were the postoperative complications and the success rate. Fifty-one patients were enrolled in this study; the etiology of mandibular defect was trauma in 39 patients (76.5%) and resection of benign or malignant tumors in 12 patients (23.5%). The complication rate was (58.8%) and the success rate was (94.1%); the only factor that significantly increased the incidence of postoperative complications was the size of the defect. Reconstruction plates demonstrated a high success rate despite the high complication rate. Segmental defects caused by trauma were smaller than those created after tumor resection and the only factor that increased complication rate was the size of the defect; other factors did not affect the complication rate.

Topology optimization of patient-specific mandibular reconstruction plates and physical validation

Background: Patient-Specific Implants (PSIs) are used for multiple indications, for instance for reconstruction plates to bridge segmental mandibular defects. As Additive Manufacturing (AM) can be applied for fabrication, implants with intricate 3D structures are becoming available. Topology Optimization (TO) is used in industrial applications to optimize the material distribution in a product, based on pre-defined constraints, but is largely unknown in medical applications. There's been a recent increase in the interest around design requirements of PSIs for mandibular reconstruction plates from a mechanical point of view.

Application of deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flaps in reconstruction of complex oromandibular defects

To evaluate the reliability and effectiveness of a deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flap (DCIA-IIOF) in reconstruction of complex oromandibular defect. Between January 2010 and December 2015, DCIA-IIOFs were used to repair complex oromandibular defects in 11 patients. There were 8 males and 3 females, with an age of 27-75 years (median, 56 years). Original disease was lower gingival squamous cell carcinoma in 7 cases (T 3N 1M 0 in 2 cases, T 3N 2M 0 in 1 case, T 4N 0M 0 in 2 cases, and T 4N 2M 0 in 2 cases), osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma in 2 cases, central mandibular squamous cell carcinoma in 1 case (T 4N 0M 0), and mandibular malignant fibrous histiocytoma in 1 case. The length of mandibular bone defects ranged from 7 to 10 cm (mean, 8 cm), and the area of the mucosal defects ranged from 5 cm×3 cm to 7 cm×4 cm. Preoperative ultrasonic identification of the DCIA and its ascending branch was routinely performed. The DCIA-IIOF was harvested by using an anterograde dissection technique, of which the iliac island was used for segmental mandibular defect repair and the musculofascial island for soft tissue and mucosal defect repair. All 11 cases were followed up 15-75 months (median, 37 months). All flaps survived after operation, without necrosis of both iliac island and oblique internal musculofascial island. One patient had a mild submandibular infection which healed after wound drainage and intravenous antibiotics. At 1 month after operation, the color and texture of the musculofascial island were similar to oral mucosa without contracture, and the occluding relation was good for all patients. At 6 months after operation, the mouth opening hardly improved in 2 patients who had osteoradionecrosis; 1 patient who underwent postoperative radiotherapy had restriction of mouth opening; the remaining 8 patients had normal month opening and normal diet. Three patients died of cancer recurrence, 2 patients died of other diseases (encephalorrhagia in 1 case and myocardial infarction in 1 case), and the others survived without recurrence during follow-up. No patient developed abdominal hernia during follow-up. DCIA-IIOF is a reliable flap in reconstruction of complex oromandibular defects. The occluding relation after operation is good and the mucosal lining is soft. This technique provides an effective option for moderate complex oromandibular defects repair.

Research of dental implant inserted in 3‐dimensional hydroxyapatite scaffolds with stripe patterns on pore surface for repairing canine segmental mandibular bone defects

Research of dental implant inserted in 3‐dimensional hydroxyapatite scaffolds with stripe patterns on pore surface for repairing canine segmental mandibular bone defects

Spontaneous Regeneration of Bone in Segmental Mandibular Defect.

To highlight the spontaneous regeneration of mandibular segmental defects in young and pediatric cases and to review the literature of this unusual and rare phenomenon. Two case reports of a 17-year old male and a 8-month-old infant has been presented who underwent resection of mandible for benign tumors. These two cases have been compared with the existing literature of 61 cases published till date. Spontaneous regeneration of mandible as a viable reconstructive option is not practically feasible. The consistency and predictability of the phenomenon is questionable. Bone grafting should probably be done immediately in all cases, even in young patients if a delay would interfere with quality of life. In infants and small children though, we propose that immediate reconstruction may be avoided to allow some regeneration at the defect site. If it does not occur, secondary reconstruction may then be considered.

Localized low-dose rhBMP-2 is effective at promoting bone regeneration in mandibular segmental defects.

At least 26% of recent battlefield injuries are to the craniomaxillofacial (CMF) region. Recombinant human bone morphogenetic protein 2 (rhBMP-2) is used to treat CMF open fractures, but several complications have been associated with its use. This study tested the efficacy and safety of a lower (30% recommended) dose of rhBMP-2 to treat mandibular fractures. rhBMP-2 delivered via a polyurethane (PUR) and hydroxyapatite/β-tricalcium phosphate (Mastergraft®) scaffold was evaluated in a 2 cm segmental mandibular defect in minipigs. Bone regeneration was analyzed at 4, 8, and 12 weeks postsurgery using clinical computed tomography (CT) and rhBMP-2, and inflammatory marker concentrations were analyzed in serum and surgery-site drain effluent. CT scans revealed that pigs treated with PUR-Mastergraft® + rhBMP-2 had complete bone bridging, while the negative control group showed incomplete bone-bridging (n = 6). Volumetric analysis of regenerated bone showed that the PUR-Mastergraft® + rhBMP-2 treatment generated significantly more bone than control by 4 weeks, a trend that continued through 12 weeks. Variations in inflammatory analytes were detected in drain effluent samples and saliva but not in serum, suggesting a localized healing response. Importantly, the rhBMP-2 group did not exhibit an excessive increase in inflammatory analytes compared to control. Treatment with low-dose rhBMP-2 increases bone regeneration capacity in pigs with mandibular continuity defects and restores bone quality. Negative complications from rhBMP-2, such as excessive inflammatory analyte levels, were not observed. Together, these results suggest that treatment with low-dose rhBMP-2 is efficacious and may improve safety when treating CMF open fractures. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1491-1503, 2019.

Retrospective Analysis of Mandibular Segmental Defects Treated with Non-Vascularized Bone Grafts and Their Outcomes

In recent years, there has been a shift toward reconstructing mandibular segmental defects using vascularized bone grafts (VBG), which are now becoming the workhorse of mandibular reconstruction. VBG provide reconstruction of large and composite defects, work well in irradiated fields, and allow for immediate reconstruction. Despite the advantages mentioned, it is important to note that VBG necessitate lengthy admission, require specialized training and equipment, and in many cases, the bulk of bone provided is suboptimal either in contour, esthetics, or for implant placement. Non-vascularized bone grafts (NVBG), on the other hand, lack these drawbacks as the surgery tends to be less technique-sensitive with a shorter admission time and provide a larger bulk of bone than the VBG. Nevertheless, many surgeons avoid NVBG use for defects over 6cm in length as studies including those by Pogrel et al.1 and Foster et al.2 showed increase in failure rates of NVBG in larger defects.

Development of a novel resection and cutting guide for mandibular reconstruction using free fibula flap

IntroductionThe authors developed a semi-standardised resection and cutting guide for mandibular reconstruction with free fibula flap based on data of mandible sizes and angles. MethodsAfter analyzing the angles and lengths of mandibular angles and segments on computer tomography, a partly-adjustable resection guide for the mandible and cutting guide for the fibula were designed. ResultsAfter testing and optimizing the guides on plastic models and cadavers, the guides were successfully used for mandible resection and reconstruction with free fibula flap in 8 patients with segmental mandibulectomy. Application of the cutting and resection guides and functional results like occlusion and aesthetic appearence were satisfactory in all cases. ConclusionsThe developed semi-standardised device is a helpful instrument for facilitating reconstruction of segmental mandibular defects with free fibula flaps. No extensive preoperative preparation and 3D printing is necessary which can avoid additional costs for virtual planning. Especially for lower budget health systems this can be an alternative to virtual planning.

Functional Mandibular Reconstruction With Double-Barrel Fibular Flap and Primary Osseointegrated Dental Implants Improve Facial Esthetic Outcome

Osseointegrated dental implants in fibular free flaps can be used to reconstruct segmental mandibular defects resulting from head and neck resections. The double-barrel fibular flap (DBFF) has been applied as a modified method to overcome insufficient fibular width. This article describes the use of the DBFF with simultaneous dental implant placement as a superior method for esthetic mandibular reconstruction. From 2012 to 2015, 26 patients underwent mandibular reconstruction with a free fibular flap and immediate dental implant placement after segmental mandibulectomies. Twelve patients received the DBFF and the other 14 patients received the conventional single-barrel fibular flap (SBFF). Palatal mucosal grafting was performed when necessary. Functional and esthetic outcomes were evaluated after 31 to 45months of follow-up. All microvascular fibula transplantations were successful. All patients completed prosthodontic rehabilitation. The mean follow-up of patients after reconstruction was 36.3months (range, 31 to 45months). The facial esthetic score was significantly higher in patients treated with the DBFF than with the SBFF after 24 and 30months (P<.05). There was no significant difference in marginal bone resorption between the DBFF and SBFF groups (P>.05). This 1-stage surgical method is safe and reliable. Use of the DBFF markedly decreased the height discrepancy between the native and new mandible and achieved a better lower face esthetic outcome than the SBFF. Osseointegrated dental implantation was adequate to achieve satisfactory dental rehabilitation in the DBFF group.

Non-vascularised fibular bone graft after vascular crisis: compensation for the failure of vascularised fibular free flaps

After reconstruction of a segmental mandibular defect with a fibular free flap, a vascular crisis can be detected clinically and a “no-flow” phenomenon found during re-exploration. Traditional methods used to solve this include removal of the failed flap and delayed mandibular reconstruction, or restoration of the defect with a functional reconstruction plate or contralateral fibular free flap. Our aim therefore was to investigate under what circumstances it is feasible to use a non-vascularised fibular bone graft (NVFB) as a free bone graft after the failure of a vascularised fibular free flap. From 1 January 2010–31 December 2014, 10 patients who had NVFB after failure of a fibular free flap were included in the study. All patients were treated at the Peking University School and Hospital of Stomatology. NVFB were preserved successfully without infection in all 10 cases, and follow-up imaging showed that it had incorporated well with the residual mandible, the basic function and facial aesthetics of which were maintained. In conclusion we have identified that by precise selection of patients, detailed preoperative planning, and meticulous postoperative care, NVFB can be used as a “rescue” technique after failure of a fibular free flap, and can successfully restore the segmental mandibular defect and facial contour.

Clinical experience with a novel structure designed bridging plate system for segmental mandibular reconstruction: The TriLock bridging plate

The innovative TriLock Bridging Plate System (Medartis AG, Switzerland) was developed to reduce common complications related to conventional mandibular reconstruction plates. The novelties regarding the plating system concern the cross-strut structure in the centerpiece, the bendable side elements and the reduction of the plate's thickness to 2.0 mm 4 different models are available, which cover lateral and central segmental mandibular defects. The plating system has only been introduced at selected maxillofacial units so far and clinical assessment is still lacking. Thus, the aim of the study was to analyze the novel Bridging Plate system in terms of its clinical applicability, rate of trimming and postoperative outcomes in a first investigation over 6 months. The study includes 25 patients with segmental mandibular resection, who underwent reconstruction with TriLock Bridging Plates. According to the assessment parameters, excellent clinical applicability was stated in 48%. The overall trimming rate was found to be 88%. Mostly adaptions to the distal bendable elements of lateral plates were performed. The occurrence of postoperative complications was 16%. Plate fracture occurred in 4%. With reference to the results, the novel plating system represents a viable method for segmental mandibular reconstruction, however, further evaluation is needed, for a more detailed analyzation.