Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, 550 First Avenue, New York, NY 10003, USA.
OBJECT: Determine long-term use of mandible height with use of stress-shielding reconstruction plates for free fibula flap mandible construction.
DESIGN: Retrospective single-blinded medial record review.
SUBJECTS: Seventy patients who had fibula free flap mandible reconstructions performed for 10 years. Patients who underwent radiotherapy were excluded.
METHODS: Review of 70 fibula free flap mandible reconstructions performed for the last 10 years in a city hospital revealed 7 patients (10%) who had resections for benign odontogenic diseases . All had a three-dimensional cast model made, on which the reconstruction plate was bent to the desired shape preoperatively. Free fibula height on panoramic x-ray images taken preperatively and at 2 and 12 months postoperatively.
RESULTS: Seven (10%) patients met criteria for the study. Bone height was maintained at 2 months postperatively, but at 12 months, there was a statistically significant loss of fibular bone height averaging 20% in the anterior, body and ramus areas (P < 0.05). Despite this, all patients were considered eligible for dental rehabilitations, and 4 of 7 patients have had osseointegrated implants placed.
CONCLUSIONS: As opposed to miniplates, increased resorption may have been due to the stress-shielding phenomenon unique to a reconstruction plates. However, this did not seem to affect the ability to place osseointegrated implants.
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