(383) Plate Complications in Maxillary Reconstruction Utilizing Virtual Surgical Planning

Introduction: The fibula free flap has allowed reconstruction of maxillary defects with vascularized osteocutaneous tissue with the possibility of dental implants. Plate complications continue to remain a long-term issue. Virtual surgical planning (VSP) allows for improved accuracy and optimal surgical reconstruction with patient specific flaps (PSP). There is currently minimal published data regarding the long-term plate complications of PSP.

Methods: Retrospective chart review of patients from Jan 2010 to July 2022 who underwent reconstruction of a maxillary defect with fibula free flap. All patients had patient specific plates created during pre-operative VSP.

Results: A total of 39 patients underwent PSP fibula reconstruction of maxillary defects. Average age was 57.4 + 16.9 years with an equal distribution of males to females. The majority of the maxilla resections were due to oral cavity malignancies (n=30), with squamous cell carcinoma being the most common (46.1%, n=18). Median number of fibula segments created for reconstruction was 2. Ten plates (25.6%) were removed on average 33.6 months after initial placement. The majority (n=5, 50%) were removed due to exposed hardware with only one patient having hardware infection. Two patients (20%) had exposed bone that was drilled down and hardware was concurrently removed since there good bony union. One patient had the plate removed to allow for dental implant placement. No plates were broken and only one plate (10 %) required removal due to loose screws. No patients required plate removal and replacement. Eighteen patients had post-operative radiation therapy and this trended toward an increased risk of plate complications (OR 3.1, CI 0.68-15.88).

Conclusions: VSP appears to improve the accuracy of maxillary reconstructions with PSP and minimizes the plate complications.