The 2004 Annual Meeting (January 14-20, 2004) of OASYS_NEW

Not yet assigned to a slot - 12:00 AM

The Lateral Oromandibular Defect: Is it Appropriate to Use a Bridging Reconstruction Plate Combined with a Soft Tissue Revascularized Flap?

Nussenbaum B1, Chepeha DB2, Jones L2, Bradford CR2, Terrell J2, Wolf GT2, and Teknos TN2. (1) Otolaryngology-Head & Neck Surgery, Washington University, 660 South Euclid Ave, Campus Box 8115, St. Louis, MO, USA, (2) Otolaryngology-Head & Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1904 Taubman, Ann Arbor, MI, USA

Objectives: To determine if a “volume approach” to lateral oromandibular reconstruction can significantly reduce the plate complication rate and be an alternative to osseocutaneous reconstruction; to determine which clinical-demographic factors are important in choosing this reconstructive approach.

Methods and Materials: Prospective case series of 2 reconstructive approaches with a retrospective evaluation of outcome. Forty patients were evaluated from August 1995 to March 2001. There were 26 males and 14 females with a median age of 61 years. Minimum follow up was 18 months. Mean follow up was 24 months. Inclusion criteria were patients with a lateral mandible defect encompassing the entire alveolar canal and a complex soft tissue defect that were reconstructed with a revascularized soft tissue flap and a titanium hollow screw reconstruction plate. Group 1 (16 patients) underwent a reconstruction which restored the volume of the soft tissue defect. Group 2 (24 patients) underwent a reconstruction which over-reconstructed the defect such that the soft tissue pushed out and around the reconstruction plate (volume approach).

Results: Plate exposure rate: group 1, 5/16 (31%) versus group 2, 2/24 (8%), p<0.05. Mean time to exposure 10 months. Plate fracture rate: dentulous, 6/23 (26%) versus edentulous, 0/17 (0%), p<0.05. Mean time to fracture 21 months. Gastrostomy tube dependence: group 1, 6/15 (40%) versus group 2, 5/23 (22%), p=0.2. Multivariable linear regression and decision analysis will be presented.

Conclusions: The “volume approach” ameliorates plate exposure and reduces gastrostomy tube dependence. Revascularized osseocutaneous reconstruction is still required for dentulous patients.


Back to Scientific Paper Session B
Back to American Society for Reconstructive Microsurgery

Back to The 2004 Annual Meeting (January 14-20, 2004)