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What Factors Influence Success of Mandibular Reconstructions With Patient-Specific Selective Laser Melted
Jeffrey S Marschall1, Mitchell Frerichs2, Thomas Keith2
1Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Iowa Hospital and Clinics, Iowa City, IA.
Summary
Patient-specific reconstruction plates rarely fracture. However, using more screws near defects increases failure risk, while bone grafts may reduce it in craniomaxillofacial surgery.
Area of Science:
- Craniomaxillofacial surgery
- Biomaterials engineering
- Surgical outcomes research
Background:
- Patient-specific reconstruction is increasingly used in craniomaxillofacial surgery.
- Limited data exists on factors influencing the success of these reconstructions.
Purpose of the Study:
- To determine the failure rate of patient-specific hardware.
- To identify risk factors associated with hardware failure in these reconstructions.
Main Methods:
- A retrospective cohort study analyzed data from 131 patients treated with selectively laser melted (SLM) reconstruction plates.
- Predictor variables included demographics, etiology, mandibular characteristics, and plate specifics (e.g., screw number).
- Time to screw failure was the primary outcome, assessed via radiographic and clinical data.
Main Results:
- The overall hardware failure rate was low, with 0.8% plate fracture and 7.6% screw failures.
- Increased screws proximal or distal to the defect significantly elevated screw failure hazard (HR=1.63 and HR=1.58, respectively).
- Bone grafting in continuity defects reduced screw failure hazard by 85% (HR=0.15).
Conclusions:
- Selectively laser melted (SLM) reconstruction plate fractures are uncommon.
- Optimizing screw placement and considering bone grafts for defects are crucial for minimizing hardware failure.
- These findings can inform surgical planning to improve patient-specific reconstruction outcomes.
