Comparison between patient-specific implants and hand-bent plates in mandibular reconstruction.
Alloplastic reconstruction is often required following segmental mandibular resection (SMR). Hardware-associated complications, especially hardware fractures, almost invariably necessitate explantation. Recent advances in manufacturing techniques promise potential advantages over traditional methods, including increased fracture resistance. However, to date, there is no scientific evidence confirming whether these benefits translate to real-life clinical conditions.
A total of 210 patients underwent SMR followed by alloplastic reconstruction between 2007 and 2019 at Hannover Medical School. The indications for SMR were tumor (n = 208; n = 196 squamous cell carcinoma) and osteoradionecrosis (n = 2). The mean patient age was 60.61 years, with a range of 14 to 89 years. The cohort comprised 146 male patients (69.52%) and 64 female patients (30.48%). Of these, 113 patients underwent reconstruction using hand-bent reconstruction plates (RP), while 97 received patient-specific implants (PSI). The incidence of hardware-related complications (HRC) was compared between the RP and PSI groups.
HRC occurred in 72 cases (34.29%). Exposure of the implant accounted for 47 cases (22.38%) while fractures occurred in 18 cases (8.57%), showing no significant difference between PSI and RP. Time from diagnosis until resection and reconstruction was not delayed due to the use of PSI.
The choice of alloplastic manufacturing method does not affect HRC rates. PSI is offering benefits beyond fracture resistance and does not delay SMR.
HRC remain challenging and may additionally impair patients' quality of life. In particular, hardware fractures often necessitate additional surgical interventions, underlining the need to identify the factors that contribute to their occurrence. To the best of the author's knowledge, this is the largest cohort study comparing RP and PSI with respect to HRC.
A total of 210 patients underwent SMR followed by alloplastic reconstruction between 2007 and 2019 at Hannover Medical School. The indications for SMR were tumor (n = 208; n = 196 squamous cell carcinoma) and osteoradionecrosis (n = 2). The mean patient age was 60.61 years, with a range of 14 to 89 years. The cohort comprised 146 male patients (69.52%) and 64 female patients (30.48%). Of these, 113 patients underwent reconstruction using hand-bent reconstruction plates (RP), while 97 received patient-specific implants (PSI). The incidence of hardware-related complications (HRC) was compared between the RP and PSI groups.
HRC occurred in 72 cases (34.29%). Exposure of the implant accounted for 47 cases (22.38%) while fractures occurred in 18 cases (8.57%), showing no significant difference between PSI and RP. Time from diagnosis until resection and reconstruction was not delayed due to the use of PSI.
The choice of alloplastic manufacturing method does not affect HRC rates. PSI is offering benefits beyond fracture resistance and does not delay SMR.
HRC remain challenging and may additionally impair patients' quality of life. In particular, hardware fractures often necessitate additional surgical interventions, underlining the need to identify the factors that contribute to their occurrence. To the best of the author's knowledge, this is the largest cohort study comparing RP and PSI with respect to HRC.
Authors
Linderkamp Linderkamp, Papazacharias Papazacharias, Lewandowski Lewandowski, Bettag Bettag, Mast Mast, Lentge Lentge, Jehn Jehn, Neuhaus Neuhaus, Gellrich Gellrich, Korn Korn
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