Stability and complications of miniplates for mandibular reconstruction with a fibular graft: outcomes for 544 patients

Fibular flaps are usually used for the reconstruction of the mandible, but the use of plate systems, including miniplates and reconstruction plates, has recently been debated. We have made a retrospective study of 544 consecutive patients who had fibular grafts with miniplates used for fixation, and also made retrospective measurements of orthopantomographs from 37 patients to assess the stability of the miniplates used in the fibular flaps. When miniplates were used with fibular flaps there were 10.3% (56/544) complications, of which 4.8% (26/544) were loosening of the screws, 2.6% (14/544) fracture of the plate, 1.5% (8/544) exposure of the plate, and 6.4% (35/544) infection. The median (IQR) time at which the complications occurred was 24 (7–48) months. We conclude that loosening of screws is common at the binding interface near the condyle and in the molar region; plates are more likely to fracture near the binding interface in proximity to the molar region; and plates at the chin are the most likely to be exposed. Diabetes and the use of radiotherapy were associated with complications. Our data suggest that miniplates used for mandibular reconstruction are relatively reliable.