Lateral oromandibular defect: when is it appropriate to use a bridging reconstruction plate combined with a soft tissue revascularized flap?
BACKGROUND
A quasi-experimental retrospective study was undertaken to evaluate a new concept of free tissue volume restoration combined with bridging reconstruction plate (compartment approach) to reduce plate-related complication rates.


METHODS
We evaluated 40 patients with large lateral mandible defects and associated complex soft tissue defects reconstructed with a revascularized soft tissue flap and titanium hollow screw reconstruction plates. A case-control comparison was performed based on reconstruction type: restoration of soft tissue defect (conventional approach-group 1) versus over-reconstruction of soft tissue defect (compartment approach-group 2).


RESULTS
Plate exposure rate was 6 of 16 (38%) in group 1 versus 2 of 24 (8%) in group 2, and the difference was statistically significant (p = .04). The mean time to exposure was 10 months. Plate fracture rate was 6 of 23 (26.1%) in dentulous patients versus 1 of 17 (5.9%) in edentulous patients. Gastrostomy tube dependence was 6 of 16 (38%) in group 1 versus 6 of 24 (25%) in group 2.


CONCLUSIONS
The "compartment approach" reduces plate exposure rate and gastrostomy tube dependence. Revascularized osseocutaneous reconstruction is still required in dentulous patients.
Chepeha
Douglas B
DB
Department Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan 48109-0312, USA. dchepeha@umich.edu
Teknos
Theodoros N
TN
Fung
Kevin
K
Shargorodsky
Josef
J
Sacco
Assuntina G
AG
Nussenbaum
Brian
B
Jones
Lamont
L
Eisbruch
Avraham
A
Bradford
Carol R
CR
Prince
Mark E
ME
Moyer
Jeffrey S
JS
Lee
Julia S
JS
Wolf
Gregory T
GT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000601:surgery*; D056948:Orthognathic Surgical Procedures; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps