Placement of Reinforcement Plates in Mandibular Marginal Resection and Prevention of Intraoral Exposure

Marginal mandibulectomy can substantially reduce residual mandibular height, increasing the risk of pathological fracture. Lateral reconstruction plates provide reinforcement but carry a risk of intraoral exposure, especially with skin grafting. We report a technique optimizing plate placement along the inferior border to prevent exposure. A 65-year-old woman with mandibular gingival carcinoma (cT1N0M0) underwent marginal mandibulectomy and split-thickness skin grafting, requiring reinforcement due to limited occlusal support and a residual mandibular height <10 mm. To prevent proximity to the skin graft, a 2.8-mm reconstruction plate was pre-bent on a patient-specific model to fit the inferior border, fixed bicortically, and the resection was performed using an ultrasonic aspirator. Postoperative radiographs confirmed a minimum residual height of 6.3 mm. At the 2-year follow-up, no pathological fractures or plate exposure occurred. Shaping the reconstruction plate along the inferior border is a practical strategy to maintain mechanical strength and minimize complications in patients with minimal residual bone height. However, this is a preliminary report of a single case, and further accumulation of cases is required to validate the efficacy and safety of this technique.