Feasibility of alloplastic mandibular reconstruction in patients following removal of oral squamous cell carcinoma

Ettl, Tobias; Driemel, Oliver; Dresp, Bernd V.; Reichert, Torsten E.; Reuther, Jürgen; Pistner, Hans

doi:10.1016/j.jcms.2009.04.011

« Previous Next »Journal of Cranio-Maxillo-Facial Surgery
Volume 38, Issue 5 , Pages 350-354, July 2010

Feasibility of alloplastic mandibular reconstruction in patients following removal of oral squamous cell carcinoma

Tobias Ettl, MD, DMD
- Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Germany
- Both authors contributed equally to this work.
Oliver Driemel, MD, DMD, PhD
- Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Germany
- Both authors contributed equally to this work.
Bernd V. Dresp, DMD
- Department of Oral and Maxillofacial Surgery (Chair: Prof. A. Kübler, MD, DMD, PhD; Chair Emeritus: Prof. J. Reuther, MD, DMD, PhD), University of Wuerzburg, Germany
Torsten E. Reichert, MD, DMD, PhD
- Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Germany
Jürgen Reuther, MD, DMD, PhD
- Department of Oral and Maxillofacial Surgery (Chair: Prof. A. Kübler, MD, DMD, PhD; Chair Emeritus: Prof. J. Reuther, MD, DMD, PhD), University of Wuerzburg, Germany
Hans Pistner, MD, DMD, PhD
- Department of Oral and Maxillofacial Surgery (Chair: Prof. H. Pistner, MD, DMD, PhD), HELIOS Hospital Erfurt, Germany
- Prof. Dr. Dr. Hans PISTNER, Klinik für Mund-, Kiefer- und Gesichtschirurgie, Plastische Operationen, Helios Klinikum Erfurt, Nordhäuser Straße 74, 99089 Erfurt, Germany. Tel.: +49 361/781 2231; Fax: +49 361/781 2232.

Received 22 April 2008; accepted 30 April 2009. published online 08 June 2009.

Summary

Introduction

Microvascular bone grafts have evolved as the preferred technique for mandibular reconstruction in irradiated tumour patients. However immediate reconstruction by bridging plates remains an option for patients whose clinical condition is not favourable for microsurgical reconstruction. This retrospective study evaluates the performance of alloplastic mandibular reconstruction in patients following removal of oral squamous cell carcinoma.

Patients and methods

Three hundred and thirty-four patients with primary (biopsy proven) oral squamous cell carcinoma without distant metastasis (stages II–IV), who were all treated by segmental mandibular resection and reconstruction by means of a titanium bridging plate were included. Two hundred and seventy-two patients received preoperative treatment, consisting of concomitant radiochemotherapy (RCT) (n=228), chemotherapy (n=34) and radiotherapy (n=10). Median follow-up was 5.1 years (min 0.3, max 18.0).

Results

The median 2-year-disease-specific survival rate (DSS) was 81.6%. Five-year-DSS and 10-year-DSS was 71.8% and 62.0%, respectively. One hundred and thirty-six plates were removed due to infection with intra- and/or extraoral exposure, seven plates because of fracture. Preoperative RCT (p=0.027), mandibular defects including the symphysis (p=0.016) and heavy smoking at the time of diagnosis (p=0.042) were associated with infection-related failure of the reconstruction plates.

Conclusion

Reconstruction of mandibular defects with titanium bridging plates seems crucial in heavy smoking tumour patients with preoperative RCT as well as in mandibular defects including the symphysis.

Keywords: oral squamous cell carcinoma, plate reconstruction, neoadjuvant radiochemotherapy, complications, symphysis