Medical Student, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Resident, USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
J Oral Maxillofac Surg. 2021 Aug;79(8):1760-1768. doi: 10.1016/j.joms.2021.02.009. Epub 2021 Feb 18.
Plate extrusion after mandibular reconstruction is a complication that imposes significant morbidity on the patient. The goal of this study is to estimate the incidence of plate extrusion after mandible reconstruction with a vascularized free flap and to identify the factors associated with plate extrusion.
This was a retrospective cohort study involving patients who underwent mandibular reconstruction from October 2008 to July 2019 at LAC + USC or Keck Hospital of USC. Inclusion criteria were age ≥ 18 years, single-stage mandibular reconstruction with vascularized free flap, and follow-up of at least 12 months. Relevant demographic, intraoperative, and postoperative data were collected. The primary outcome was postoperative plate extrusion within the 12-month follow-up. Descriptive, univariate, and multivariate analyses were performed. Statistical significance was set at P ≤ .05.
A total of 102 patients were included in this study. The majority received a fibula free flap (90%) for a malignant neoplasm (76%). All patients had at least 12 months of follow-up. The rate of plate extrusion was 16%, with the majority of those patients undergoing plate removal (69%). After adjusting for postoperative fistula, soft tissue, and length of hospitalization, we found that any history of smoking (odds ratio = 12.8; confidence interval, 1.57 to 104.2), number of osteotomies (odds ratio 3.07; confidence interval, 1.09 to 8.6), flap nonviability (odds ratio = 18.2; confidence interval, 2.22 to 148.8) were associated with plate extrusion on multivariate analysis. Postoperative soft tissue infection approached significance.
This study demonstrates that smoking history, number of osteotomies, and flap nonviability are associated with plate extrusion after mandible reconstruction. Performing fewer osteotomies when possible to avoid excessively small flap bone segments and minimizing postoperative complications may improve long-term outcomes after mandibular reconstruction.
下颌骨重建后发生钢板突出是一种会给患者带来严重发病率的并发症。本研究的目的是估计带血管游离皮瓣下颌骨重建后钢板突出的发生率，并确定与钢板突出相关的因素。
这是一项回顾性队列研究，纳入 2008 年 10 月至 2019 年 7 月在 LAC+USC 或 Keck 医院接受单阶段带血管游离皮瓣下颌骨重建的患者。纳入标准为年龄≥18 岁、单阶段带血管游离皮瓣下颌骨重建和随访至少 12 个月。收集了相关的人口统计学、术中及术后数据。主要结局为术后 12 个月内的钢板突出。进行了描述性、单变量和多变量分析。统计学显著性设为 P≤0.05。
本研究共纳入 102 例患者。大多数患者（90%）因恶性肿瘤（76%）接受了腓骨游离皮瓣。所有患者均有至少 12 个月的随访。钢板突出的发生率为 16%，大多数患者（69%）行钢板取出术。在调整术后瘘管、软组织和住院时间后，我们发现任何吸烟史（比值比=12.8；置信区间，1.57 至 104.2）、截骨数量（比值比 3.07；置信区间，1.09 至 8.6）、皮瓣不可存活（比值比=18.2；置信区间，2.22 至 148.8）与多变量分析中的钢板突出相关。术后软组织感染接近显著。
本研究表明，吸烟史、截骨数量和皮瓣不可存活与下颌骨重建后钢板突出有关。尽可能少做截骨术以避免皮瓣骨段过小，并尽量减少术后并发症，可能会改善下颌骨重建后的长期结果。
