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P. Daniel Knott, MD; Jeffrey D. Suh, MD; Vishad Nabili, MD; Joel A. Sercarz, MD; Christian Head, MD; Elliot Abemayor, MD; Keith E. Blackwell, MD

Arch Otolaryngol Head Neck Surg. 2007;133(12):1302-1306.

Objective  To identify the incidence of hardware and bone-healing complications in patients who underwent locking mandibular reconstruction plate (LMRP) fixation of vascularized bone grafts for reconstruction of segmental mandibular defects.

Design  Case series.

Setting  Academic tertiary care medical center.

Patients  One hundred one patients who had undergone LMRP fixation of vascularized bone grafts for reconstruction of segmental mandibular defects with a minimum follow-up of 6 months.

Main Outcome Measures  Association of patient- and defect-related characteristics with the incidence of loose screws, osteosynthesis nonunion, and complications necessitating hardware removal.

Results  The incidence of loose screws was 0.8% in 984 locking screws implanted. The incidence of nonunion was 0.7% in 290 osteosyntheses. Overall, 15 of 101 LMRPs (14.8%) were removed because of hardware-related complications, with plate extrusion (n = 10) the most common complication necessitating hardware removal. Pathologic diagnosis (P = .002), previous treatment with hyperbaric oxygen (P < .001), radiation therapy (P < .001), and cancer recurrence (P = .03) were statistically significant predictors of LMRP-related complications at univariate analysis. At multivariate analysis, previous treatment with hyperbaric oxygen (P < .046) remained a statistically significant predictor of LMRP-related complications.

Conclusions  In patients undergoing mandibular reconstruction, LMRPs are highly effective for fixation of vascularized bone grafts, with a high incidence of bone-graft healing and a low incidence of complications related to loose screws. Nevertheless, there remains a 15% incidence of hardware-related complications, most related to hardware extrusion. Previous treatment with hyperbaric oxygen is a statistically significant predictor of LMRP-related complications.

Author Affiliations: Division of Head and Neck Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles. Dr Knott is now with the Head and Neck Institute, The Cleveland Clinic Foundation, Cleveland, Ohio.

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