title: Computer-Assisted Designed and Manufactured Procedures Facilitate the Lingual Application of Mandible Reconstruction Plates.
abstract: OBJECTIVE
  Lingual positioning of mandible reconstruction plates can prevent typical complications such as plate exposure and orocutaneous fistulas. The aim of this study was to evaluate the feasibility and clinical outcomes of lingually applied patient-specific reconstruction plates.
  
  
  METHODS
  A retrospective cohort study of patients managed with reconstruction plates positioned at the lingual side of the mandible was performed. The following outcome variables were analyzed: feasibility and handling of the lingual application, fitting accuracy, and postoperative complications.
  
  
  RESULTS
  The study sample included 8 patients (4 women, 4 men) with a mean age of 68.8 years (range, 43 to 79 yr). The indications for plate use were defect-like zones owing to multiple fractures in the atrophic mandible (n = 2) and segmental defects attributed to squamous cell carcinoma, osteomyelitis, and bisphosphonate-related osteonecrosis (n = 6). Off-the-shelf reconstruction plates, which were intraoperatively bent (n = 2) or pre-bent to a stereolithographic model (n = 1), or fully computer-assisted designed and computer-assisted manufactured (CAD/CAM) patient-specific reconstruction plates (n = 5) were used. Lingual application of reconstruction plates was feasible in all cases and considerably facilitated by the CAD/CAM plates. The fitting accuracy was high. Within an average follow-up period of 15.3 months, no loosening of plates or screws, plate fracture, or orocutaneous fistula occurred and no dysphagia was observed with the exception of 1 case, in which plate exposure was due to extreme soft tissue thinning and tumor recurrence.
  
  
  CONCLUSIONS
  Lingual application of CAD/CAM patient-specific reconstruction plates is technically feasible with high accuracy. It has great potential for low complication rates, especially in unfavorable soft tissue conditions.
authors.affiliation: Specialist OMFS, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany. Electronic address: florian.probst@med.uni-muenchen.de.
authors.forename: Florian Andreas
authors.initials: FA
authors.lastname: Probst
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Metzger
authors.affiliation: Professor and Head, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Ehrenfeld
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany.
authors.forename: Carl-Peter
authors.initials: CP
authors.lastname: Cornelius
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D017076:Computer-Aided Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D063175:Mandibular Reconstruction / Q000295:instrumentation*; D008875:Middle Aged; D011183:Postoperative Complications; D011474:Prosthesis Design; D012189:Retrospective Studies; D016896:Treatment Outcome