title: The bridging lateral mandibular reconstruction plate revisited.
abstract: BACKGROUND
  Lateral oromandibular reconstruction using a soft tissue free flap with a first-generation locking mandibular reconstruction plate (MRP) was rejected in a previous series by the senior author (K.E.B.) owing to a high incidence of delayed plate extrusion through the cheek skin.
  
  
  OBJECTIVE
  To reexamine this method of reconstruction using a second-generation, low-profile MRP.
  
  
  METHODS
  A prospective case series of 27 patients with segmental defects of the lateral mandible after treatment of head and neck cancer.
  
  
  METHODS
  An academic tertiary care referral center.
  
  
  METHODS
  All patients had mandibular continuity restored using the Leibinger Locking System (Stryker Leibinger Inc, Kalamazoo, Mich) MRP. Associated soft tissue defects were repaired using radial forearm (n = 22) or rectus abdominis (n= 5) free flaps.
  
  
  METHODS
  Incidence of hardware-related complications.
  
  
  RESULTS
  All microvascular flap transfers were successful. One patient experienced a plate fracture 9 months after reconstruction. Only 1 patient experienced external plate exposure, 6 months after undergoing reconstruction of a through-and-through defect. Reconstruction was successful in 25 (93%) of the cases after a median follow-up period of 19.5 months.
  
  
  CONCLUSIONS
  The high incidence of external plate exposure in patients undergoing lateral oromandibular reconstruction using soft tissue free flaps and first-generation locking MRPs may have resulted from a plate geometry that was prone to result in extrusion. After a similar length of follow-up, the incidence of reconstructive failure was reduced by using a low-profile, rounded-contour MRP. Final assessment of the durability of this technique will require long-term follow-up.
authors.affiliation: Department of Surgery, University of California Los Angeles School of Medicine, USA.
authors.forename: K E
authors.initials: KE
authors.lastname: Blackwell
authors.forename: V
authors.initials: V
authors.lastname: Lacombe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019930:Mandibular Prosthesis Implantation; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D009959:Oropharyngeal Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D013524:Surgical Flaps