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

Wednesday, October 4, 2023

10:42 AM - 10:48 AM East Coast USA Time

Location: 205ABC

Presenting Author(s)

Keshav V. Shah, BS

Medical Student
Perelman School of Medicine
Philadelphia, PA, United States

Co-Author(s)

Saawan D. Patel, BBA

Medical Student
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States
Austin C. Cao, BA

Medical Student
Perelman School of Medicine
Philadelphia, Pennsylvania, United States
Karthik Rajasekaran, MD

Assistant Professor, Head and Neck Oncologic & Reconstructive Surgeon, Director of QI
Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
Philadelphia, Pennsylvania, United States
SC

Steven B. Cannady, MD

Assistant Professor of Otorhinolaryngology: Head and Neck Surgery
Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
Philadelphia, PA, United States
AC

Ara A. Chalian, MD

Professor, ORL/HNS, Hospital Patient Safety Officer
Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
philadelphia, PA, United States

Senior Author(s)

RB

Robert M. Brody, MD

Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania, USA

Disclosure(s):

Keshav V. Shah, BS: No relevant relationships to disclose.

Introduction: Mandibular plate reconstruction (MPR) is often indicated after tumor excision, osteoradionecrosis repair, and traumatic bone loss to restore oral functionality and facial cosmetics. Nevertheless, high rates of post-operative morbidity and plate complications have limited its efficacy.

Methods: A retrospective cohort study of patients who underwent MPR in the University of Pennsylvania health system from 2013 to 2022 was conducted. Data was collected regarding patient demographics, medical history, diagnostic workup, surgical management, and adjuvant therapy to determine rates of and risk factors associated with plate complications, defined as plate infection, extrusion, and/or explantation. Analysis was performed using Wilcoxon rank sum test, Pearson’s chi-squared test, and Fisher’s exact test. Overall survival was calculated with Kaplan-Meier analysis.

Results: Of the 188 patients analyzed, 44 (23%) had a plate complication [infection: 22 (12%); extrusion: 19 (10%); explantation: 31 (18%)]. Smoking status (p=0.009) and history in pack-years (p=0.007), number of screws (p=0.003) and plates (p=0.05) used in reconstruction, and location of implant (p=0.02) were associated with plate complications. Stratifying by complication demonstrated that failure of proper wound healing after surgery was associated with plate infection (p=0.007) and extrusion (p=0.002), and post-surgical soft tissue infection was associated with plate explantation (p=0.02). Overall survival between patients with and without plate complications approached significance (p=0.07).

Conclusions: Plate complications are relatively common in MPR, with smoking history, number of screws and plates, surgical site, improper wound healing, and postoperative soft tissue infection being associated with plate infection, extrusion, and/or explantation. Hence, minimizing surgical hardware and postoperative morbidity may improve MPR outcomes.