Affiliation:
1. Department of Otolaryngology–Head and Neck Surgery Oregon Health and Science University Portland Oregon U.S.A.
2. Department of Otolaryngology–Head and Neck Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania U.S.A.
3. Department of Oral Maxillofacial Surgery Oregon Health Science University Portland Oregon U.S.A.
4. Oregon Health Science University School of Medicine Portland Oregon U.S.A.
Abstract
ObjectiveAssess the long‐term plate complications with patient‐specific plates (PSPs) created with computer‐aided design (CAD) and computer‐aided manufacturing (CAM) for fibula free flap reconstructions for mandibular defects.MethodsRetrospective chart review from January 2010 to July 2022 of patients who underwent mandibular reconstruction with a fibula free flap and PSP. Primary outcome was plating‐related complications, defined as plate exposure, fracture, loose screws, and plate removal.ResultsA total of 221 patients underwent PSP fibula reconstruction. Average age was 59.8 + 14.3 years old with male to female ratio of 2:1. Squamous cell carcinoma of the mandible was the most common reason for resection, 47.5%, n = 105. Plate removal occurred in 11% of patients (n = 25) about 17.4 months after the initial surgery. Plates were removed due to exposure (76%, n = 19) or screw loosening (24%, n = 6). Malignancy was associated with an increased risk of plate complications when compared to benign tumor (odds ratio [OR] 9.04, confidence interval [CI] 1.36–3.85), osteonecrosis (OR 1.38, CI 0.59–3.48), and trauma (OR 1.26, CI 0.23–12.8). Postoperative radiation therapy (OR 2.27, CI 1.07–4.82, p = 0.026) and surgical site infection (OR 9.22, CI 4.11–21.88, p = 0.001) were associated with more plate complications.ConclusionsCAD creates PSPs that remain stable in the majority of patients over the long term. Plate removal is less compared to non‐PSP reconstruction. Consideration of the soft tissue envelope over the plate and management of perioperative infection at the time of surgery should be entertained.Level of EvidenceLevel 4 Laryngoscope, 2024