Marginal mandibulectomy can substantially reduce residual mandibular height, increasing the risk of pathological fracture. Lateral reconstruction plates provide reinforcement but carry a risk of intraoral exposure, especially with skin grafting. We report a technique optimizing plate placement along the inferior border to prevent exposure. A 65-year-old woman with mandibular gingival carcinoma (cT1N0M0) underwent marginal mandibulectomy and split-thickness skin grafting, requiring reinforcement due to limited occlusal support and a residual mandibular height <10 mm. To prevent proximity to the skin graft, a 2.8-mm reconstruction plate was pre-bent on a patient-specific model to fit the inferior border, fixed bicortically, and the resection was performed using an ultrasonic aspirator. Postoperative radiographs confirmed a minimum residual height of 6.3 mm. At the 2-year follow-up, no pathological fractures or plate exposure occurred. Shaping the reconstruction plate along the inferior border is a practical strategy to maintain mechanical strength and minimize complications in patients with minimal residual bone height. However, this is a preliminary report of a single case, and further accumulation of cases is required to validate the efficacy and safety of this technique.
Morimoto et al. (Mon,) studied this question.