Plating in microvascular reconstruction of the mandible: can fixation be too rigid?
OBJECTIVE
Determine long-term loss of mandible height with use of stress-shielding reconstruction plates for free fibula flap mandible reconstruction.


METHODS
Retrospective single-blinded medical record review.


METHODS
Seventy patients who had fibula free flap mandible reconstructions performed for 10 years. Patients who underwent radiotherapy were excluded.


METHODS
Review of 70 fibula free flap mandible reconstructions performed for the last 10 years in a city hospital revealed 7 patients (10%) who had resections for benign odontogenic diseases. All had a three-dimensional cast model made, on which the reconstruction plate was bent to the desired shape preoperatively. Free fibula height on panoramic x-ray images taken preoperatively and at 2 and 12 months postoperatively.


RESULTS
Seven (10%) patients met criteria for the study. Bone height was maintained at 2 months postoperatively, but at 12 months, there was a statistically significant loss of fibular bone height averaging 20% in the anterior, body, and ramus areas (P < 0.05). Despite this, all patients were considered eligible for dental rehabilitation, and 4 of 7 patients have had osseointegrated implants placed.


CONCLUSIONS
As opposed to miniplates, increased resorption may have been due to the stress-shielding phenomenon unique to a reconstruction plates. However, this did not seem to affect the ability to place osseointegrated implants.
Zoumalan
Richard A
RA
Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, 550 First Avenue, New York, NY 10003, USA. Richard.Zoumalan@nyumc.org
Hirsch
David L
DL
Levine
Jamie P
JP
Saadeh
Pierre B
PB
D001860:Bone Plates; D001862:Bone Resorption / Q000000981:diagnostic imaging; D016025:Bone Transplantation / Q000000981:diagnostic imaging / Q000379:methods; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008137:Longitudinal Studies; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods*; D008953:Models, Anatomic; D016348:Osseointegration / Q000502:physiology; D011183:Postoperative Complications; D011862:Radiography, Panoramic; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D016037:Single-Blind Method; D013314:Stress, Mechanical; D013524:Surgical Flaps
D015921:Dental Implants