The Bridging Lateral Mandibular Reconstruction Plate Revisited

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Abstract
IN 1996, BLACKWELL et al1 reported a series of 14 patients who underwent lateral oromandibular reconstruction using soft tissue free flaps in conjunction with bridging titanium hollow screw reconstruction plate (THORP) mandibular reconstruction plates (MRPs). This method of reconstruction was rejected owing to a high incidence of delayed hardware-related complications. The incidence of hardware-related reconstructive failure was 29% in 14 patients after a median follow-up period of 16.5 months. One patient experienced fracture of a THORP MRP, while 3 patients suffered from hardware extrusion through the cheek skin. Analysis of this experience led to the conclusion that segmental defects of the lateral mandible were optimally reconstructed using a vascularized bone–containing free flap. Because of the critical role of the tongue for speech and swallowing and the complex 3-dimensional anatomy of the oropharynx, it was recognized that the soft tissue component of vascularized bone–containing free flaps would be inadequate to reconstruct the soft tissue component of some lateral oromandibular defects. In this situation, it would be necessary to carry out a vascularized bone–containing free flap to restore mandibular continuity and a simultaneous soft tissue free flap to reconstruct the soft tissues.