Volume-length impact of lateral jaw resections on complication rates

被引:51
作者
Arden, RL
Rachel, JD
Marks, SC
Dang, K
机构
[1] Wayne State Univ, Dept Otolaryngol Head & Neck Surg, Sch Med, Detroit, MI 48201 USA
[2] Wayne State Univ, Sch Med, Ctr Hlth Care Effectiveness Res, Detroit, MI 48201 USA
关键词
D O I
10.1001/archotol.125.1.68
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
Objective: To study the relationship between soft tissue volume loss and bone resection length following lateral segmental mandibulectomy with plate reconstruction and complication rates. Design: Retrospective case review of 31 patients (1989-1996), with average follow-up of 37.2 months, who were treated by lateral composite resection for oral cavity and/or oropharyngeal malignancy with primary reconstruction by defect-bridging plates. Setting: Academic tertiary care referral center. Interventions: Thirty patients had stainless steel and 1 patient a vitallium reconstruction plate to restore mandibular continuity. Soft tissue defects were repaired with pectoralis myocutaneous flaps (n = 25), skin grafts (n = 4), a radial forearm free flap (n = I), or primary closure (n = 1). All patients received preoperative (n = 6) or postoperative (n = 25) radiation therapy. Main Outcome Measures: Overall and hardware-related complications. Results: All 31 initial soft tissue repairs were successful. Subsequent complications occurred in 14 patients (45%),which included plate exposure (29%), loosened screws requiring hardware removal ((29%), fistula (14%), local wound infection (14%), osteomyelitis (7%), and plate fracture (7%). Average time to complication was 7.7 months. Complication rates were 81% for bone defects greater than 5.0 cm, and 7% for those less than 5.0 cm. Bivariate analysis indicated bone resection lengths greater than 5.0 cm to be a significant predictor of both hardware-related (P = .02) and overall complications (P = .005), whereas soft tissue volume resections greater than 240 cm(3) were found only to be marginally significant (P = .04) for overall complications. Conclusion: Extirpative losses involving more than 5 cm of bone, or tissue volume greater than 240 cm(3), are associated with unacceptably high complication rates when reconstructed with solid screw stainless steel plates and this warrants consideration of alternative techniques for long-tetm stability.
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页码:68 / 72
页数:5
相关论文
共 14 条
[1]  
Blackwell KE, 1996, ARCH OTOLARYNGOL, V122, P672
[2]   THE FREE-FLAP AND PLATE IN OROMANDIBULAR RECONSTRUCTION - LONG-TERM REVIEW AND INDICATIONS [J].
BOYD, JB ;
MULHOLLAND, RS ;
DAVIDSON, J ;
GULLANE, PJ ;
ROTSTEIN, LE ;
BROWN, DH ;
FREEMAN, JE ;
IRISH, JC .
PLASTIC AND RECONSTRUCTIVE SURGERY, 1995, 95 (06) :1018-1028
[3]  
CHOW JM, 1986, LARYNGOSCOPE, V96, P768
[4]  
FEINSTEIN AR, 1996, MULTIVARIABLE ANAL, P477
[5]  
FRISANCHO AR, 1990, ANTHROPOMETRIC STAND, P77
[6]  
KELLMAN RM, 1987, OTOLARYNG CLIN N AM, V20, P519
[7]   CRITICAL ANALYSIS OF MANDIBULAR RECONSTRUCTION USING AO RECONSTRUCTION PLATES [J].
KIM, MR ;
DONOFF, RB .
JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 1992, 50 (11) :1152-1157
[8]   THE AO SYSTEM FOR PRIMARY MANDIBULAR RECONSTRUCTION [J].
LAVERTU, P ;
WANAMAKER, JR ;
BOLD, EL ;
YETMAN, RJ .
AMERICAN JOURNAL OF SURGERY, 1994, 168 (05) :503-507
[9]   RIGID RECONSTRUCTION PLATES FOR IMMEDIATE RECONSTRUCTION FOLLOWING MANDIBULAR RESECTION FOR MALIGNANT-TUMORS [J].
LINDQVIST, C ;
SODERHOLM, AL ;
LAINE, P ;
PAATSAMA, J .
JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 1992, 50 (11) :1158-1163
[10]  
SCHUSTERMAN MA, 1991, PLAST RECONSTR SURG, V88, P588