Good functional reconstruction of the mandible remains challenging for the maxillofacial surgeon. The fibula osteocutaneous flap is widely used as a method of mandibular reconstruction and it can withstand multiple osteotomies and a thus requires hardware to adapt and hold the segments. There has also been significant improvement in the plate hardware. This is a single centre retrospective audit looking at the plate related complications following reconstructions of the mandible. They look at 41 reconstructions between 2004 and December 2012.  Most common; 30 cases were resections for squamous cell carcinomas. Sixteen patients had postoperative adjuvant radiotherapy and one preoperative radiotherapy. Seven patients had chemotherapy in addition to standard fractioned radiotherapy. The authors studied the complications of the plates used. Three types of plates were used: the mandible plates 2.0, locking plate 2.0 and locking plate 2.4. The commonest plates used the miniplates 86 with two complications, followed by 2.0 mandible plates, 2 in 14 and then 2.0 locking plate 1 in 12 complications. Initially there were concerns that miniplates with their smaller size would have less strength and predispose to more complications. However, the newer miniplates with their greater malleability and adaptability and lower profile seem to have fewer complications. This study confirms that and the authors’ first choice is the miniplates. A drawback is that with the use of multiple plates, a period of intermaxillary fixation is required to maintain the occlusion. Also interesting is the fact that most complications occurred early, within six months, and as expected the majority presented in patients that received radiotherapy. In the context of patients, the study might be considered small but the fact that a total of 86 miniplates were used with only five ‘complications’ is fairly conclusive.

Evaluation of plate-related complications and efficacy in fibula free flap mandibular reconstruction.
Zavattero E, Fasolis M, Garzino-Demo P, et al.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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