Cementing stability: innovative polymethyl methacrylate-assisted salvage of mandibular reconstruction hardware

Hardware exposure after mandibular reconstruction poses significant management challenges. Incomplete removal of reconstruction plates and screws may compromise stability, particularly when osseointegration prevents screw retrieval. A patient who underwent mandibular resection for odontogenic keratocyst with non-vascularized fibular reconstruction developed exposure of the fixation plate. During revision surgery, exposed screws were removed, but several screws remained firmly integrated within the reconstructed bone and could not be retrieved. To prevent destabilization, the plate was retained with the remaining screws, while polymethyl methacrylate (PMMA) bone cement was adapted in the vacant screw sites to restore stability. Postoperative healing was uneventful, and the reconstruction plate remained stable. This report highlights the novel use of PMMA bone cement as a salvage method for plate stabilization in maxillofacial reconstruction, adapting a material widely established in orthopedic surgery for craniomaxil-lofacial application.