Alloplastic mandibular reconstruction: a systematic review and meta-analysis of the current century case series

BACKGROUND: Alloplastic mandibular reconstruction remains insufficiently predictable, with no systematic reviews to assess its scope and limitations.

METHODS: The PubMed, CINAHL, EMBASE, and Web of Science databases were searched for English study reports, published in the current century, of mere alloplastic surgical reconstruction of mandibular ablative defects.

RESULTS: In 14 articles, there were 944 patients, with a median age of 58.7 years (interquartile range, 53.2 to 62 years); 58.7 percent (interquartile range, 66.7 to 78.6 percent) were male. Cases of squamous cell carcinoma per study constituted 93.5 percent (interquartile range, 81.5 to 100 percent). Defects were mostly lateral (Boyd classification) (60.5 percent; interquartile range, 56.2 to 62 percent) and received mostly conventional bridging plates (in 64.3 percent of the studies) and pedicled flaps (45.3 percent; interquartile range, 37.1 to 58.3 percent); 60.7 percent (interquartile range, 53.5 to 58.8 percent) received adjuvant therapy. At 32-month follow-up, the complication and failure rates were 40.1 percent (interquartile range, 26.7 to 58.6 percent) and 30.8 percent (interquartile range, 11.7 to 48.1 percent), respectively. The overall survival rate was 55 percent (interquartile range, 27.8 to 74 percent). Radiotherapy seemed to be a relative risk factor for complications (1.387; p = 0.014) and plate loss (1.585; p = 0.006). Crossing the midline seemed to be a relative risk factor for plate exposure (1.533; p = 0.000) and overall complications (1.385; p = 0.002).

CONCLUSIONS: The results should be generalized cautiously. Alloplastic reconstructive surgery faces a remarkable lack of evidence. Relatively high complication and failure rates are areas of further concern.