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Risk factors and surgical refinements of postresective mandibular reconstruction: a retrospective study.

Sakakibara A, Hashikawa K, Yokoo S, Sakakibara S, Komori T, Tahara S - Plast Surg Int (2014)

Bottom Line: Results.Radiation therapy and closure without any flaps were significantly related to infection or plate exposure.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.

ABSTRACT
Background. Postresective mandibular reconstruction is common in cases of oral and mandibular tumors. However, complications such as infection, plate exposure, or plate fracture can occur. We identified several significant risk factors of complications after reconstructive surgery and compared the effectiveness of different surgical techniques for reducing the incidence of complications. Methods. This study is a retrospective analysis of 28 oromandibular cancer cases that required reconstructive surgery between January 1999 and December 2011 at Kobe University Graduate School of Medicine in Japan. All cases were classified using Hashikawa's CAT and Eichner's classification methods. Then, we determined whether these classifications and different treatment or surgical methods were significantly related to complications. Results. Complications after mandibular reconstruction occurred in 10/28 patients (36%). Specifically, five patients had plate fractures, four had plate exposures, and one had an infection. Radiation therapy and closure without any flaps were significantly related to infection or plate exposure. The wrap-around technique of securing reconstruction plates was used in 14 cases, whereas the run-through technique was used in two cases. Conclusions. The success of mandibular reconstruction depends on both mechanical and biological factors, such as the location of defects, presence of occlusions, and the amount of vascularization of the flap.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier plot showing the success rate of mandibular reconstruction in the patients in this study.
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fig6: Kaplan-Meier plot showing the success rate of mandibular reconstruction in the patients in this study.

Mentions: The distribution of cases according to the CAT and Eichner's classification methods is shown in Tables 1 and 2, respectively. In addition, the relationships between different types of treatment and the occurrence of complications are shown in Tables 3–7. Specifically, five patients received radiation therapy (range: 50–70 Gy). Four of these patients received radiation therapy within 12 weeks of surgery, while 1 of the patients had recurred after radiation therapy performed ten years previously (Table 3). Although complications occurred regardless of whether radiation therapy was administered, we found a statistically significant relationship between radiation therapy and complications (Tables 3 and 7). In 27 patients, three different types of soft-tissue free flaps were used, while a simple closure was used in the remaining patient (Table 4). Although at least one patient developed either an infection or plate exposure in each technique, only the simple closure technique was significantly related to complications (Tables 4 and 7). Furthermore, among the 28 cases that we examined, 10 patients (36%) developed complications approximately two years after reconstruction (mean: 25.5 months, range: 0.5–82.4 months; Table 5) and nine patients died within 51 months of surgery. However, a Kaplan-Meier analysis showed that there was no specific period when a complication was likely to occur (Figure 6). Among the 10 patients who developed complications, three received radiation therapy and nine reconstructions were performed with a musculocutaneous flap, but all three types of flaps examined in this study were equally common.


Risk factors and surgical refinements of postresective mandibular reconstruction: a retrospective study.

Sakakibara A, Hashikawa K, Yokoo S, Sakakibara S, Komori T, Tahara S - Plast Surg Int (2014)

Kaplan-Meier plot showing the success rate of mandibular reconstruction in the patients in this study.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4150385&req=5

fig6: Kaplan-Meier plot showing the success rate of mandibular reconstruction in the patients in this study.
Mentions: The distribution of cases according to the CAT and Eichner's classification methods is shown in Tables 1 and 2, respectively. In addition, the relationships between different types of treatment and the occurrence of complications are shown in Tables 3–7. Specifically, five patients received radiation therapy (range: 50–70 Gy). Four of these patients received radiation therapy within 12 weeks of surgery, while 1 of the patients had recurred after radiation therapy performed ten years previously (Table 3). Although complications occurred regardless of whether radiation therapy was administered, we found a statistically significant relationship between radiation therapy and complications (Tables 3 and 7). In 27 patients, three different types of soft-tissue free flaps were used, while a simple closure was used in the remaining patient (Table 4). Although at least one patient developed either an infection or plate exposure in each technique, only the simple closure technique was significantly related to complications (Tables 4 and 7). Furthermore, among the 28 cases that we examined, 10 patients (36%) developed complications approximately two years after reconstruction (mean: 25.5 months, range: 0.5–82.4 months; Table 5) and nine patients died within 51 months of surgery. However, a Kaplan-Meier analysis showed that there was no specific period when a complication was likely to occur (Figure 6). Among the 10 patients who developed complications, three received radiation therapy and nine reconstructions were performed with a musculocutaneous flap, but all three types of flaps examined in this study were equally common.

Bottom Line: Results.Radiation therapy and closure without any flaps were significantly related to infection or plate exposure.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.

ABSTRACT
Background. Postresective mandibular reconstruction is common in cases of oral and mandibular tumors. However, complications such as infection, plate exposure, or plate fracture can occur. We identified several significant risk factors of complications after reconstructive surgery and compared the effectiveness of different surgical techniques for reducing the incidence of complications. Methods. This study is a retrospective analysis of 28 oromandibular cancer cases that required reconstructive surgery between January 1999 and December 2011 at Kobe University Graduate School of Medicine in Japan. All cases were classified using Hashikawa's CAT and Eichner's classification methods. Then, we determined whether these classifications and different treatment or surgical methods were significantly related to complications. Results. Complications after mandibular reconstruction occurred in 10/28 patients (36%). Specifically, five patients had plate fractures, four had plate exposures, and one had an infection. Radiation therapy and closure without any flaps were significantly related to infection or plate exposure. The wrap-around technique of securing reconstruction plates was used in 14 cases, whereas the run-through technique was used in two cases. Conclusions. The success of mandibular reconstruction depends on both mechanical and biological factors, such as the location of defects, presence of occlusions, and the amount of vascularization of the flap.

No MeSH data available.


Related in: MedlinePlus