FACTORS INVOLVED IN LONG-TERM AND SHORT-TERM MANDIBULAR PLATE EXPOSURE

Objectives: To evaluate and to compare rates and timing of exposure of alloplastic mandibular plates by plate type and tissue reconstruction technique. Design: A retrospective review series of 92 consecutive pa tients for 4 years (mean follow-up, 30 months). Setting: National Canc er institute-designated comprehensive cancer center in a freestanding cancer hospital. Patients: Seventy-nine patients received alloplastic mandibular plates for segmental defects, and 13 patients received comp ression plates for mandibular osteotomies following ablative cancer su rgery, including 21 titanium hollow osseointegrating reconstruction, 4 1 Storz, 16 Synthes, and 5 AO/ASIF (Arbeitsgemein schott fur Ostcosynt hese fragen/Association for the Study of Internal Fixation) plates. Pr imary flap repair was provided by 71 pedicled soft tissue and 19 osseo cutaneous free flaps, with primary closure in the remaining 2. Interve ntion: Most of the reconstructions of the mandibular defect was with a n alloplastic plate with musculocutaneous flap or revascularized bone graft. Outcome Measures: Clinically apparent intraoral or extraoral pl ate exposure. Results: Plate exposure occurred in 25 cases. Nine plate s were exposed extraorally, at a mean postoperative interval of 40 wee ks. The remaining 16 plates were exposed intraorally at a mean postope rative interval of 16 weeks. There was no significant difference in th e exposure rates of different plate types or methods of reconstruction . The titanium hollow osseointegrating reconstruction plate had a simi lar exposure rate compared with the other plates. Size and site of the defect were the only significant predictors of plate exposure. Radiot herapy and postoperative complications did not affect the rate of expo sure. Conclusions: Extraoral plate exposure occurs less commonly and l ater in the postoperative period than intraoral exposure, suggesting d ifferent causes. Plate type and type of flap reconstruction do not aff ect the rate of exposure. This may reflect long follow-up.