Long-Term Complications in Patient-Specific Plates for Maxillary Reconstruction

Objectives: Virtual surgical planning (VSP) allows for optimal reconstruction of maxillary defects with fibula free flaps. Current data are limited regarding long-term complications of patient-specific plates (PSPs) in this setting. Our objective was to determine long-term complications of PSPs in maxillary reconstruction using fibula free flaps.

Methods: A retrospective chart review was performed on patients undergoing maxillary reconstruction with a fibula free flap and PSP between January 2010 to July 2022. The primary outcomes were plate-related complications, which were defined as plate exposure, fracture, removal or evidence of loose screws. Secondary outcomes were wound infection, nonunion, or flap failure.

Results: A total of 39 patients underwent fibular reconstruction of maxillary defects using PSP. The average age was 56 years, with 56% of patients being female. There were 14 (35.8%) patients with plate-related complications, 10 (25.6%) underwent plate removal, 12 (30.8%) developed exposed hardware, 2 (5.1%) had loose screws, and none had a plate fracture. The average time to plate removal was 2.76 ± 1.94 years. With regard to age, sex, tobacco or alcohol use, diabetes, hypothyroidism, preoperative radiation therapy, number of fibula segments, type of cancer, postoperative radiation therapy, or whether the patient underwent orodental rehabilitation, there were no significant differences between patients who did and did not experience plate complications.

Conclusions: VSP allows for patient-specific reconstruction of maxillary defects with a fibula free flap that remains stable in the majority of patients. In the long term, up to 25% of patients may require plate removal, but the reconstruction remains stable.

Level of evidence: Level 4.