A-O PLATE MANDIBULAR RECONSTRUCTION - A COMPLICATION CRITIQUE

Immediate A-O plate mandibular reconstruction was used in 31 patients, following the excision of malignant disease. This five-year retrospective study shows that 48% (15/31) of the patients are living (one with recurrence), with a mean follow-up of 30 months (range nine to 60 months). The mean survival of the deceased patients was 11 months (range two weeks to 46 months). Postoperative complications are evaluated with respect to the mandibular defect, radiation status, dentition, adjuvant onlay bone grafting and T stage. Briefly, 11/31 patients (36%) enjoyed an uneventful recovery, 9/31 (29%) developed a minor wound complication, 6/31 (19%) developed a major wound complication and 5/31 (16%) had significant aspiration. Four plates were removed and an additional three plates were exposed. In general, those patients in whom the condylar head was removed, or in whom the mandibular resection crossed the midline, experienced more wound complications (67% vs. 37%). Simultaneous onlay bone grafting almost doubled the complication rate and this reconstructive technique has been abandoned. No significant contribution to complication rate was made by radiation status, T stage or dentition in our patient population. In addition, four plates have been uneventfully irradiated postoperatively, and five patients have been successfully fit with dentures over their reconstruction plates.