Volume-length impact of lateral jaw resections on complication rates

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.