Evaluation of plate-related complications and efficacy in fibula free flap mandibular reconstruction.

AIM: The objective of this study was to evaluate the incidence of plate-related complications after vascularized bony reconstruction of the mandible, comparing the plate type used. PATIENTS AND METHODS: Between 2004 and December 2012, a total of 41 free osteocutaneous fibula flaps have been used in an equal number of patients for reconstruction of the mandible, at the Division of Maxillofacial surgery, San Giovanni Battista Hospital, University of Turin. Malignant pathology was the most common indication for segmental mandibulectomy.Patient outcomes were retrospectively evaluated with special attention to plate complications such as plate fracture, exposure, infection, and bony nonunion.The types of reconstruction plates used were mandible plates 2.0, locking plates 2.0, miniplates (<2.0), and locking 2.4 plates. RESULTS: Mandible plates 2.0 were used in 14 patients, locking plates 2.0 in 12 patients, and locking 2.4 plates in 4 patients. The most commonly used plates were miniplates, which were used in 86 patients.A total of 5 plate complications occurred after 41 procedures in an equal number of patients.Two complications occurred in patients receiving 2.0 mandible plates (2/14). One complication occurred in patients receiving 2.0 locking plates (1/12). Two complications occurred in patients receiving miniplates (2/86). CONCLUSIONS: In our experience, miniplates are not associated to a high rate of complications comparing to other plates. The advantage of these plates and the low rate of complications make them our first choice for mandibular reconstructions.

Growth-associated protein-43 immunoreactivity in human oral mucosa in dentate subjects, in edentulous patients and after implant-anchored rehabilitation.

OBJECTIVES: This study investigates expression of the neural growth-associated protein 43 (GAP-43) in the oral mucosa of (A) normal dentate subjects, (B) edentulous patients rehabilitated with conventional denture and (C) those rehabilitated with mandibular implant-retained overdentures (MIR-OVD), in the long term. This study evaluates morphological changes in the distribution and representation of sensory terminations and corpuscles in the alveolar mucosa under the action of different masticatory or prosthetic loads, in the three clinical groups. MATERIAL AND METHODS: GAP-43 immunoreactivity (-ir) was compared with the distribution of nerves fibres in the mucosa, as visualised using anti-protein gene product 9.5 (PGP 9.5), a general marker for peripheral nerves and terminals. RESULTS: GAP-43-ir was found to be highly expressed in the corium and submucosa in specimens from edentulous subjects wearing conventional denture and presenting a reduced number of PGP 9.5-ir nerves in the mucosa, but not in specimens from control subjects or patients wearing MIR-OVD, which on the contrary show a higher number of PGP 9.5-ir mucosal sensory fibres. CONCLUSION: As the mucosa under traditional denture has been shown to possess reduced innervation and the histological aspect of chronic overloading, these results may be considered indicative of a tentative induction to nerve re-growth in the under-innervated epithelium, or as a response to chronic inflammation. The detection of GAP-43-ir suggests that human oral mucosa presents signs of potential nerve plasticity also in the elderly, and that the type of rehabilitation and the condition of masticatory load transfer to the mucosa have important effects on the nerves underneath.