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

TY - JOUR

T1 - Alloplastic mandibular reconstruction: a systematic review and meta-analysis of the current century case series

AU - Sadr-Eshkevari, Pooyan

AU - Rashad, Ashkan

AU - Vahdati, Seyed Aliakbar

AU - Garajei, Ata

AU - Bohluli, Behnam

AU - Maurer, Peter

N1 - Ashkan Rashad, D.M.D., M.D., Department of Oral and Maxillofacial Surgery, Reinkenheide Hospital, Postbrookstraße 103, 27574 Bremerhaven, Germany

PY - 2013/9/1

Y1 - 2013/9/1

N2 - 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.

AB - 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.

KW - Carcinoma, Squamous Cell

KW - Graft Survival

KW - Humans

KW - Mandibular Neoplasms

KW - Mandibular Reconstruction

KW - Models, Statistical

KW - Postoperative Complications

KW - Surgical Flaps

KW - Survival Rate

KW - Transplantation, Homologous

KW - Treatment Outcome

U2 - 10.1097/PRS.0b013e31829ad0d9

DO - 10.1097/PRS.0b013e31829ad0d9

M3 - SCORING: Journal article

C2 - 23985653

VL - 132

SP - 413e-27e

JO - PLAST RECONSTR SURG

JF - PLAST RECONSTR SURG

SN - 0032-1052

IS - 3

ER -