← Back to List

Program Number: B061
Session Name: Poster Session

Perioperative Risk Factors Predicting Hardware Exposure After Mandibulectomy And Reconstruction

Mychael T Spencer, MEd¹; Emily H Chestnut, BS¹; Alexander J Jones, MD²; Janice L Farlow, MD, PhD²; Michael G Moore, MD²; Avinash V Mantravadi, MD²; ¹Indiana University School of Medicine; ²Indiana University School of Medicine, Department of Otolaryngology - Head and Neck Surgery

Background: Mandibulectomy is often necessary for managing tumors, infections, or trauma in the head and neck region. The defect is reconstructed using osteocutaneous free flaps and titanium plates to fixate the bone segments. Unfortunately, postoperative exposure of the mandibular hardware can significantly impair quality of life and usually necessitates extensive revision surgery and reconstruction. We hypothesize that individuals with vasculopathic conditions and other factors that impair wound healing are at a higher risk of experiencing hardware plate exposure following mandibular
reconstruction.

Methods: All adults undergoing mandibulectomy and osteocutaneous free flap reconstruction from 2010-2020. Demographics, patient history, surgical parameters, and follow-up data were collected. Comparisons and logistic regression were used to determine factors associated with postoperative hardware exposure.

Results: The cohort consisted of 134 predominantly white (92.5%) male (65.7%) patients with mean age 58.413.0 years, 32 (23.9%) of whom had postoperative plate exposure. Between patients with and without exposure, there were no differences observed in demographics, substance use, surgical indications, or reconstructive techniques, neoadjuvant or adjuvant chemoradiation, nor 30-day major surgical site infection. The comorbidities of peripheral vascular disease, hypothyroidism, and immunosuppression were significantly more common in the plate exposure group. In multivariate logistic regression, peripheral vascular disease (OR [95%CI] = 18.8 [1.8-196.3]), hypothyroidism (OR [95%CI] - 3.5 [1.1-10.6]), and immunosuppression (OR
[95%CI] = 11.3 [2.4-54.1]) remained significant predictors of post mandibulectomy hardware exposure.

Conclusion: Patients with pre-existing conditions such as peripheral vascular disease, hypothyroidism, and/or immunosuppression face an increased risk of hardware exposure following mandibulectomy. Recognizing these risk factors is crucial for enhancing the decision-making and counseling process shared between patients and surgeons, and it also directs practitioners to prioritize mitigating these comorbidities before surgery.

 

 

← Back to List