CAD/CAM procedures facilitate the lingual application of mandible reconstruction plates

Publication date: Available online 24 March 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Florian Andreas Probst, Marc Metzger, Michael Ehrenfeld, Carl-Peter Cornelius
PurposeLingual positioning of mandible reconstruction plates may prevent typical complications like plate exposure and orocutaneous fistulas. The aim of this study was to evaluate feasibility and clinical outcomes of lingually applied patient specific reconstruction plates (PSMP).Patients and MethodsA retrospective cohort study of patients managed with reconstruction plates, positioned at the lingual side of the mandible, was performed. The following outcome variables were analyzed: feasibility and handling concerning the lingual application, fitting accuracy, and postoperative complications.ResultsThe study sample included 8 subjects (4 female, 4 male) with a mean age of 68.8 years (range 43 - 79 years). The indications for plate use were defect-like zones due to multiple fractures in the atrophic mandible (n=2) and segmental defects attributed to squamous cell carcinoma, osteomyelitis and bisphosphonate related osteonecrosis (n=6). Either off-the-shelf reconstruction plates, which were intraoperatively bent (n=2) or prebent to a STL model (n=1) or fully CAD/CAM-manufactured patient specific reconstruction plates (n=5) were used. Lingual application of reconstruction plates was feasible in all cases and considerably facilitated by CAD/CAM-manufactured plates. The fitting accuracy was high. Within an average follow-up period of 15.3 months, no loosening of plates or screws, plate fracture, or orocutaneous fistula occurred and no dysphagia was observed with the exception of one case, where plate exposure was due to extreme soft tissue thinning and tumor recurrence.ConclusionsLingual application of CAD/CAM-manufactured patient specific reconstruction plates is technically feasible with high accuracy. It bears a great potential for low complication rates, especially in unfavourable soft tissue conditions.



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