Mandibular reconstruction and second generation locking reconstruction plates: outcome of 110 patients

Mandibular reconstruction plates have revolutionized the treatment of mandibular continuity defects following ablative or trauma surgery. This retrospective study of patients requiring mandibular reconstruction over a six year period describes the authors' experience with second generation mandibular locking reconstruction plates and identifies complications and risk factors. The use of second-generation locking reconstruction plates for the treatment of mandibular continuity defects has a 36% complication rate, which includes plate fracture, screw loosening, plate exposure, wound infection and malocclusion. The average time frame until a hardware failure (plate fracture, screw loosening) occurs is 14 months. Plate exposure is closely associated with patients who received radiation therapy, and have lateral defects reconstructed with a plate only or plate/soft tissue flap reconstruction. Plate fracture was associated with lateral defects, the presence of a postoperative dentition, and a plate only or plate/soft tissue flap reconstruction. The authors recommend the use of a primary vascularized bone reconstruction. This provides additional soft tissue support around the plate to minimize the chances of exposure. It also provides osseous support for the plate, reducing the time frame the plate endures load bearing, and minimizing the risk of plate fracture.