[Titanium miniplate fixation in head and neck cancer surgery]

To evaluate the rigid fixation with miniplates in head and neck cancer surgery.

A consecutive series of 40 patients with head and neck tumor underwent rigid fixation with the Martin titanium miniplates system in a 6 years period. The miniplates were used to fix bone graft reconstruction following mandible resection (n = 14), mandibulotomies for oral and oropharyngeal surgical access (n = 12), maxilla swinging for nasopharyngeal access (n = 11) and other purposes (n = 3). Twenty-three of all cases(57.5%) received perioperative radiotherapy with average doses of 60Gy at the osteotomy site.

Eleven of the 40 patient (22%) developed plate related complication which included 5 infections, 3 mandibular osteonecroses, 1 plate exposure, 1 screw loose and 1 nonunion. Complications were more likely to occur in patients with perioperative radiation than patients without (39.1% versus 11.8%, P = 0.079). Except one case, All the uncomplicated dentulous patients demonstrated stable and good occlusion. Oral feeding usually started on the 3-4th day after surgery. There was no need for intermaxillary fixation.

The miniplate provided stable mandibular or maxillary fixation and accurate repositioning, eliminated the need for intermaxillary fixation. The malleability and versatility of miniplate make it unique in bone graft shaping for mandibular reconstruction. Complication seems to be related to perioperative radiotherapy. Median or paramedian mandibular osteotomy, which is non-radiated region in most radiotherapy cases, is advocated.