The bridging lateral mandibular reconstruction plate revisited

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic and Reconstructive Surgery
• Head and Neck Oncology

Background:

• First-generation locking mandibular reconstruction plates (MRPs) showed high rates of extrusion during lateral oromandibular reconstruction with soft tissue free flaps.
• Previous attempts at reconstruction using these plates were associated with significant hardware-related complications, leading to rejection of the technique.

Purpose of the Study:

• To evaluate the efficacy of second-generation, low-profile locking MRPs in lateral oromandibular reconstruction.
• To determine if a modified plate design reduces the incidence of plate extrusion and reconstructive failure.

Main Methods:

• A prospective case series included 27 patients with lateral mandibular defects post-cancer treatment.
• Mandibular continuity was restored using the Leibinger Locking System MRP, with soft tissue defects repaired via radial forearm or rectus abdominis free flaps.
• The primary outcome measured was the incidence of hardware-related complications, particularly plate exposure.

Main Results:

• All microvascular free flap transfers were successful.
• Only one patient experienced plate fracture, and one patient had external plate exposure.
• Reconstruction was successful in 93% of cases after a median follow-up of 19.5 months.

Conclusions:

• The low-profile, rounded-contour design of second-generation locking MRPs effectively reduces plate extrusion compared to first-generation plates.
• This improved technique demonstrates a lower incidence of reconstructive failure in lateral oromandibular reconstruction.
• Long-term follow-up is necessary to fully assess the durability of this reconstructive method.