title: Local and systemic risk factors influencing the long-term success of angular stable alloplastic reconstruction plates of the mandible.
abstract: BACKGROUND
  After ablative surgery of the mandible, angular stable alloplastic reconstruction plates are commonly employed. The aim of the study was a long-term evaluation of local anatomical, as looking at systemic factors influencing specific complications and the failure rate of such plates.
  
  
  METHODS
  In a retrospective study covering an 11-year period, we reviewed the outcomes of angular stable plates of patients who had a segmental resection of the mandible and subsequent alloplastic reconstruction. Complications and failure rates were assessed and local (anatomical size and localization of resection) as well as systemic risk factors (age, sex, radiation therapy, smoking) evaluated.
  
  
  RESULTS
  Altogether, 162 plates were reviewed. The overall complication rate was 28% (fractures n = 8, loose screws n = 7, dehiscences n = 31) after an average time of 13 months. Cumulative survival rates of 73% after one, of 67% after 2, of 59% after 3 and of 40% after five years were observed. We found a significant correlation of increasing defect sizes to a rising complication and failure rate. Plate dehiscence occurred more often in defects including the midline (p = 0.005). Though not statistically significant, the occurrence of plate fracture was associated with lateral mandibular defects (7/8, p = 0.113). In smoking patients an earlier failure rate was seen.
  
  
  CONCLUSIONS
  The results clearly indicate that the success of alloplastic reconstruction plates of the mandible is dependent on various risk factors. They should--if possible--be used temporarily only. If not done primarily, a secondary approach with bone reconstruction is recommended.
authors.affiliation: Department of Oral-, Maxillofacial- and Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131 Mainz, Germany; Harvard Medical School, Boston, USA. Electronic address: peer.kaemmerer@gmx.de.
authors.forename: P W
authors.initials: PW
authors.lastname: Kämmerer
authors.affiliation: Private Praxis for Oral and Maxillofacial Surgery, Stresemannstrasse 7-9, Düsseldorf, Germany; Department of Oral-, Maxillofacial- and Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131 Mainz, Germany.
authors.forename: M O
authors.initials: MO
authors.lastname: Klein
authors.affiliation: Department of Oral-, Maxillofacial- and Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131 Mainz, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Moergel
authors.affiliation: Department of Oral-, Maxillofacial- and Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131 Mainz, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gemmel
authors.affiliation: Department of Oral-, Maxillofacial- and Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131 Mainz, Germany.
authors.forename: G F
authors.initials: GF
authors.lastname: Draenert
mesh_terms: D000367:Age Factors; D000368:Aged; D001672:Biocompatible Materials / Q000737:chemistry; D001860:Bone Plates / Q000009:adverse effects; D001863:Bone Screws / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery; D015331:Cohort Studies; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008339:Mandibular Neoplasms / Q000532:radiotherapy / Q000601:surgery; D063175:Mandibular Reconstruction / Q000295:instrumentation*; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016019:Survival Analysis; D014025:Titanium / Q000737:chemistry; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D014025:Titanium
keywords: Angular stable; Complications; Localization; Reconstruction mandible; Reconstruction plate; Risk factor; Smoking; Success