Florian Andreas Probst1, Marc Metzger2, Michael Ehrenfeld3, Carl-Peter Cornelius4. 1. Specialist OMFS, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany. Electronic address: florian.probst@med.uni-muenchen.de. 2. Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany. 3. Professor and Head, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany. 4. Professor, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany.
Abstract
PURPOSE: Lingual positioning of mandible reconstruction plates can prevent typical complications such as plate exposure and orocutaneous fistulas. The aim of this study was to evaluate the feasibility and clinical outcomes of lingually applied patient-specific reconstruction plates. MATERIALS AND METHODS: A retrospective cohort study of patients managed with reconstruction plates positioned at the lingual side of the mandible was performed. The following outcome variables were analyzed: feasibility and handling of the lingual application, fitting accuracy, and postoperative complications. RESULTS: The study sample included 8 patients (4 women, 4 men) with a mean age of 68.8 years (range, 43 to 79 yr). The indications for plate use were defect-like zones owing to multiple fractures in the atrophic mandible (n = 2) and segmental defects attributed to squamous cell carcinoma, osteomyelitis, and bisphosphonate-related osteonecrosis (n = 6). Off-the-shelf reconstruction plates, which were intraoperatively bent (n = 2) or pre-bent to a stereolithographic model (n = 1), or fully computer-assisted designed and computer-assisted manufactured (CAD/CAM) patient-specific reconstruction plates (n = 5) were used. Lingual application of reconstruction plates was feasible in all cases and considerably facilitated by the CAD/CAM plates. The fitting accuracy was high. Within an average follow-up period of 15.3 months, no loosening of plates or screws, plate fracture, or orocutaneous fistula occurred and no dysphagia was observed with the exception of 1 case, in which plate exposure was due to extreme soft tissue thinning and tumor recurrence. CONCLUSIONS: Lingual application of CAD/CAM patient-specific reconstruction plates is technically feasible with high accuracy. It has great potential for low complication rates, especially in unfavorable soft tissue conditions.
PURPOSE: Lingual positioning of mandible reconstruction plates can prevent typical complications such as plate exposure and orocutaneous fistulas. The aim of this study was to evaluate the feasibility and clinical outcomes of lingually applied patient-specific reconstruction plates. MATERIALS AND METHODS: A retrospective cohort study of patients managed with reconstruction plates positioned at the lingual side of the mandible was performed. The following outcome variables were analyzed: feasibility and handling of the lingual application, fitting accuracy, and postoperative complications. RESULTS: The study sample included 8 patients (4 women, 4 men) with a mean age of 68.8 years (range, 43 to 79 yr). The indications for plate use were defect-like zones owing to multiple fractures in the atrophic mandible (n = 2) and segmental defects attributed to squamous cell carcinoma, osteomyelitis, and bisphosphonate-related osteonecrosis (n = 6). Off-the-shelf reconstruction plates, which were intraoperatively bent (n = 2) or pre-bent to a stereolithographic model (n = 1), or fully computer-assisted designed and computer-assisted manufactured (CAD/CAM) patient-specific reconstruction plates (n = 5) were used. Lingual application of reconstruction plates was feasible in all cases and considerably facilitated by the CAD/CAM plates. The fitting accuracy was high. Within an average follow-up period of 15.3 months, no loosening of plates or screws, plate fracture, or orocutaneous fistula occurred and no dysphagia was observed with the exception of 1 case, in which plate exposure was due to extreme soft tissue thinning and tumor recurrence. CONCLUSIONS: Lingual application of CAD/CAMpatient-specific reconstruction plates is technically feasible with high accuracy. It has great potential for low complication rates, especially in unfavorable soft tissue conditions.
Authors: Jan J Lang; Mirjam Bastian; Peter Foehr; Michael Seebach; Jochen Weitz; Constantin von Deimling; Benedikt J Schwaiger; Carina M Micheler; Nikolas J Wilhelm; Christian U Grosse; Marco Kesting; Rainer Burgkart Journal: PLoS One Date: 2021-06-08 Impact factor: 3.240