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Arch Otolaryngol Head Neck Surg. 2007 Dec;133(12):1302-6.

Evaluation of hardware-related complications in vascularized bone grafts with locking mandibular reconstruction plate fixation.

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1
Division of Head and Neck Surgery, David Geffen School of Medicine, 62-132 CHS, University of California Los Angeles Medical Center, Los Angeles, CA 90095-1624, USA.

Abstract

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.

PMID:
18086976
DOI:
10.1001/archotol.133.12.1302
[Indexed for MEDLINE]
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