Which plate results in better stability after segmental mandibular resection and fibula free flap reconstruction?: Biomechanical analysis

Publication date: Available online 23 June 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Si-Myung Park, Jung-Woo Lee, Gunwoo Noh
ObjectiveThis study investigated the biomechanical stability of two plate systems, mini-plates and reconstruction plates, in reconstruction with fibular free flaps.Study DesignThe reconstruction models were constructed using two types of plates in representative segmental mandibular defect cases (C, L, LC1, LC2), respectively. Each model conducted a masticatory simulation approximating three clenching tasks using the muscle forces adjusted to the mandible structure used in this study. In addition, to evaluate the sensitivity of two plate systems for masticatory load changes, a sensitivity analysis was also performed by using finite element analysis.ResultsThe risks of plate fracture and screw loosening measured by stress concentrations were higher in the cases using mini-plates than those using reconstruction plates. Moreover, the mini-plate was more sensitive to varied loads than the reconstruction plate, and has less flexibility to absorb external forces. Mini-plates also caused high strain values, indicating hypertrophy risk in bone around the screw holes.ConclusionsThe use of a reconstruction plate should result in more stable surgical outcomes in most cases, but we note that the risk of atrophy may increase with the use of reconstruction plates, due to the lack of bone stimulation.



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