Comparison of Modern Rigid Fixation Plating Outcomes for Segmental Mandibular Microvascular Reconstruction. (3rd October 2018) - McCann, Adam C.
Abstract : Objectives/Hypothesis: New advances in osseous microvascular mandibular rigid fixation are being employed at many institutions. These include standardized prebent/preformed reconstruction plates as well as computer‐aided design/computer‐aided manufacturing (CAD/CAM) custom plates that are patient specific. Our goal was to assess and compare the outcomes of both of these new technologies when utilized for mandibular microvascular reconstruction. Study Design: Retrospective chart review. Methods: Subjects were categorized into two groups according to their mandibular rigid fixation technique: group 1 = prebent/preformed plates and group 2 = CAD/CAM custom plates. Primary outcome measures were 1) perioperative complications (defined as deep tissue infection, wound dehiscence resulting in bone exposure, and/or plate exposure) and 2) reoperation rates for mandibular hardware failure/explantation. Statistical analysis consisted of χ 2, Fisher exact test, and multivariable regression models. Results: A total of 142 subjects underwent microvascular mandibular reconstruction in a 6‐year period. Eighty‐nine subjects utilized prebent/preformed plates, and 53 employed CAD/CAM custom plates. Perioperative complications occurred in 32 of 89 (35.9%) subjects with prebent/preformed plates and 11 of 53 (20.7%) subjects using CAD/CAM custom plates. Reoperation requiring hardware explantation occurred in 18 of 89 (20.2%) subjects and three of 53 (5.6%) using CAD/CAM custom plates. Statistical comparison of perioperative complications between the two groups approached significance ( P = .0556), and the rate of reoperation was significant favoring CAD/CAM implants ( P = .0180). Conclusions: In our experience, CAD/CAM custom plates utilized for rigid fixation during microvascular mandibular reconstruction demonstrated fewer complications and statistically lower reoperation rates when compared with prebent/preformed plates. Level of Evidence: 2c Laryngoscope, 129:1081–1086, 2019