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Designing CAD/CAM Surgical Guides for Maxillary Reconstruction Using an In-house Approach
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Long-Term Plate Complications in Patient-Specific Plates Utilizing Computer-Aided Design.

Sara Yang1, Zoey Morton2, Mackenzie Sautter3

  • 1Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.

The Laryngoscope
|July 17, 2024
PubMed
Summary
This summary is machine-generated.

Patient-specific plates (PSPs) created with computer-aided design (CAD) and manufacturing (CAM) show long-term stability in fibula free flap mandibular reconstructions. Plate removal rates are lower compared to traditional methods, suggesting improved outcomes.

Keywords:
head and neck malignancymandibular reconstructionmicrovascular reconstruction

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Reconstructive Surgery
  • Biomaterials Engineering

Background:

  • Mandibular defects often require complex reconstructions, with fibula free flaps being a common solution.
  • Patient-specific plates (PSPs), designed using computer-aided design (CAD) and computer-aided manufacturing (CAM), offer tailored fit for these reconstructions.
  • Long-term complications associated with PSPs in this context require thorough evaluation.

Purpose of the Study:

  • To assess the incidence and nature of long-term plate-related complications in patients undergoing mandibular reconstruction with fibula free flaps utilizing PSPs.
  • To identify factors influencing the risk of plate complications in this patient population.

Main Methods:

  • A retrospective chart review was conducted for 221 patients who received fibula free flap reconstruction with PSPs between January 2010 and July 2022.
  • The primary outcome measured was plating-related complications, including plate exposure, fracture, screw loosening, and the need for plate removal.
  • Statistical analysis was performed to identify associations between patient factors, treatment variables, and plate complications.

Main Results:

  • Plate removal occurred in 11% of patients, primarily due to exposure (76%) or screw loosening (24%), at an average of 17.4 months post-surgery.
  • Malignancy as the reason for resection, postoperative radiation therapy, and surgical site infections were significantly associated with an increased risk of plate complications.
  • Odds ratios indicated higher risks for plate complications in cases of malignancy (OR 9.04) and surgical site infection (OR 9.22).

Conclusions:

  • CAD-created PSPs demonstrate long-term stability in the majority of patients undergoing fibula free flap mandibular reconstruction.
  • The rate of plate removal appears to be lower when compared to reconstructions using non-patient-specific plates.
  • Careful consideration of the soft tissue coverage over the plate and proactive management of perioperative infections are crucial for minimizing complications.