Volume-length impact of lateral jaw resections on complication rates

Objective: To study the relationship between soft tissue volume loss and bo ne resection length following lateral segmental mandibulectomy with plate r econstruction and complication rates. Design: Retrospective case review of 31 patients (1989-1996), with average follow-up of 37.2 months, who were treated by lateral composite resection f or oral cavity and/or oropharyngeal malignancy with primary reconstruction by defect-bridging plates. Setting: Academic tertiary care referral center. Interventions: Thirty patients had stainless steel and 1 patient a vitalliu m reconstruction plate to restore mandibular continuity. Soft tissue defect s were repaired with pectoralis myocutaneous flaps (n = 25), skin grafts (n = 4), a radial forearm free flap (n = I), or primary closure (n = 1). All patients received preoperative (n = 6) or postoperative (n = 25) radiation therapy. Main Outcome Measures: Overall and hardware-related complications. Results: All 31 initial soft tissue repairs were successful. Subsequent com plications occurred in 14 patients (45%),which included plate exposure (29% ), loosened screws requiring hardware removal ((29%), fistula (14%), local wound infection (14%), osteomyelitis (7%), and plate fracture (7%). Average time to complication was 7.7 months. Complication rates were 81% for bone defects greater than 5.0 cm, and 7% for those less than 5.0 cm. Bivariate a nalysis indicated bone resection lengths greater than 5.0 cm to be a signif icant predictor of both hardware-related (P = .02) and overall complication s (P = .005), whereas soft tissue volume resections greater than 240 cm(3) were found only to be marginally significant (P = .04) for overall complica tions. Conclusion: Extirpative losses involving more than 5 cm of bone, or tissue volume greater than 240 cm(3), are associated with unacceptably high compli cation rates when reconstructed with solid screw stainless steel plates and this warrants consideration of alternative techniques for long-tetm stabil ity.