Risk Factors for Plate Infection, Exposure, and Removal in Mandibular Reconstruction

Abstract

Objective: Mandibular plate reconstruction (MPR) is often indicated after tumor ablation, osteoradionecrosis excision, and traumatic bone loss to restore oral functionality and facial cosmetics. There are limited analyses identifying risk factors that lead to plate infection (PIn), exposure, and removal ("plate complications").

Study design: Retrospective cohort study.

Setting: Academic tertiary medical center.

Methods: Patients who underwent MPR from 2013 to 2022 were identified. Risk factors for plate complications were analyzed based on demographic, clinical, intraoperative, and postoperative factors. Multivariable analysis was conducted with logistic regression. Survival analysis was conducted with a Cox model.

Results: Of the 188 patients analyzed, 48 (25.5%) had a plate complication [infection: 22 (11.7%); exposure: 23 (12.2%); removal: 35 (18.6%)]. Multivariate analysis revealed predictive associations between at least 1 plate complication and the following variables: smoking status, soft tissue defect size, number of plates, average screw length, and various postoperative complications. Other associations approached the threshold for significance. Prior and adjuvant radiation therapy, type of free flap, stock versus custom plates, and perioperative antibiotic prophylaxis regimens were not associated with plate complications. No plate complication was independently associated with lower overall survival. PIn (hazard ratio, HR: 7.99, confidence interval, CI [4.11, 15.54]) and exposure (HR: 3.56, CI [1.79, 7.08]) were independently associated with higher rates of plate removal.

Conclusion: Plate complications are relatively common after MPR. Smoking history, specific disease characteristics, hardware used during surgery, and postoperative complications may help identify higher-risk patients, but additional larger-scale studies are needed to validate our findings and resolve discrepancies in the current literature.

Keywords: mandibular reconstruction; microvascular reconstruction; plate complications; plate exposure; plate infection; plate removal.

Figure 1

Unadjusted Kaplan‐Meier curve comparing 5‐year overall survival between patients who did and did not have (A) plate complications in general, (B) PRem, (C) PIn, and (D) PEx. No plate complication was associated with decreased survival. PEx, plate exposure; PIn, plate infection; PRem, plate removal.

Figure 2

Unadjusted Kaplan‐Meier curve comparing 5‐year incidence rates of PRem between patients who did and did not have (A) PIn and (B) PEx. Rates of PRem were significantly different in both cases. PEx, plate exposure; PIn, plate infection; PRem, plate removal.