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Article

Osseous Union after Mandible Reconstruction with Fibula Free Flap Using Manually Bent Plates vs. Patient-Specific Implants: A Retrospective Analysis of 89 Patients

1
Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany
2
Department of Diagnostic and Interventional Radiology and Pediatric Radiology, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany
3
Institute of Medical Informatics, Justus-Liebig-University Giessen, 35392 Giessen, Germany
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2022, 29(5), 3375-3392; https://doi.org/10.3390/curroncol29050274
Received: 11 April 2022 / Revised: 1 May 2022 / Accepted: 5 May 2022 / Published: 6 May 2022
(This article belongs to the Special Issue New Frontiers in Head and Neck Oncology)
The aim of this monocentric, retrospective clinical study was to evaluate the status of osseous union in uni- and poly-segmental mandible reconstructions regarding conventional angle-stable manually bent osteosynthesis plates (Unilock 2.0 mm) versus titan laser-melted PSI patient-specific implant’s (PSI). The clinical impact of PSI’s high stiffness fixation methods on bone healing and regeneration is still not well addressed. The special interest was in evaluating the ossification of junctions between mandible and fibula and between osteotomized fibula free flap (FFF) segments. Panoramic radiograph (OPT), computed tomography (CT) scans, or cone-beam CTs (CBCT) of patients who underwent successful FFF for mandible reconstruction from January 2005 to December 2020 were analyzed. A total number of 89 cases (28 females (31.5%), 61 males (68.5%), mean age 58.2 ± 11.3 years, range: 22.8–82.7 years) fulfilled the chosen inclusion criteria for analysis (conventional: n = 44 vs. PSI: n = 45). The present study found an overall incomplete ossification (IOU) rate of 24.7% (conventional: 13.6% vs. PSI: 35.6%; p = 0.017) for mandible to fibula and intersegmental junctions. Between osteotomized FFF segments, an IOU rate of 16% was found in the PSI-group, while no IOU was recorded in the conventional group (p = 0.015). Significant differences were registered for IOU rates in poly-segmental (p = 0.041), and lateral (p = 0.016) mandibular reconstructions when PSI was used. Multivariate logistic regression analysis identified plate exposure and type of plate used as independent risk factors for IOU. Previous or adjuvant radiotherapy did not impact incomplete osseous union in the evaluated study sample. PSI is more rigid than bent mini-plates and shields functional mechanical stimuli, and is the main reason for increasing the rate of incomplete ossification. To enhance the functional stimulus for ossification it has to be discussed if patient-specific implants can be designed to be thinner, and should be divided into segmental plates. This directs chewing forces through the bone and improves physiological bone remodeling. View Full-Text
Keywords: osseous free flaps; patient-specific implants; plate-related complications; free fibula flap; bone healing; osseous union; ossification osseous free flaps; patient-specific implants; plate-related complications; free fibula flap; bone healing; osseous union; ossification
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MDPI and ACS Style

Knitschke, M.; Sonnabend, S.; Roller, F.C.; Pons-Kühnemann, J.; Schmermund, D.; Attia, S.; Streckbein, P.; Howaldt, H.-P.; Böttger, S. Osseous Union after Mandible Reconstruction with Fibula Free Flap Using Manually Bent Plates vs. Patient-Specific Implants: A Retrospective Analysis of 89 Patients. Curr. Oncol. 2022, 29, 3375-3392. https://doi.org/10.3390/curroncol29050274

AMA Style

Knitschke M, Sonnabend S, Roller FC, Pons-Kühnemann J, Schmermund D, Attia S, Streckbein P, Howaldt H-P, Böttger S. Osseous Union after Mandible Reconstruction with Fibula Free Flap Using Manually Bent Plates vs. Patient-Specific Implants: A Retrospective Analysis of 89 Patients. Current Oncology. 2022; 29(5):3375-3392. https://doi.org/10.3390/curroncol29050274

Chicago/Turabian Style

Knitschke, Michael, Sophia Sonnabend, Fritz C. Roller, Jörn Pons-Kühnemann, Daniel Schmermund, Sameh Attia, Philipp Streckbein, Hans-Peter Howaldt, and Sebastian Böttger. 2022. "Osseous Union after Mandible Reconstruction with Fibula Free Flap Using Manually Bent Plates vs. Patient-Specific Implants: A Retrospective Analysis of 89 Patients" Current Oncology 29, no. 5: 3375-3392. https://doi.org/10.3390/curroncol29050274

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