Open reduction internal fixation for midline mandibulotomy: lag screws vs plates

Area of Science:

• Oral and Maxillofacial Surgery
• Head and Neck Oncology
• Orthognathic Surgery

Background:

• Midline mandibulotomy is a standard surgical approach for resecting oral cavity and oropharyngeal tumors.
• Limited comparative data exist regarding the efficacy of lag screw versus plate fixation for mandibular reconstruction following this procedure.

Purpose of the Study:

• To compare the clinical and radiological outcomes of internal fixation using lag screws versus plates in patients undergoing midline mandibulotomy for tumor resection.

Main Methods:

• Retrospective cohort study involving 37 patients over a 6-year period.
• Mandibular fixation was achieved using either lag screws or reconstruction plates.
• Postoperative CT scans were analyzed by a neuroradiologist to assess bone union using a standardized grading scale.

Main Results:

• Lag screw fixation demonstrated a significantly higher rate of radiologic union (90%) compared to plate fixation (41%) (P=.01).
• The average grade of union was also significantly better with lag screws (1.3) versus plates (0.67) (P=.04).
• Complications like hardware exposure and fistula formation were exclusive to the plate group.

Conclusions:

• Lag screw fixation of the mandible following midline mandibulotomy leads to superior bone union rates compared to plate fixation.
• Lag screws are particularly advantageous in patients undergoing adjuvant radiation therapy and those with increased risk of wound complications.
• The findings support considering lag screw fixation as a preferred method for midline mandibulotomy reconstruction.