Advertisement

Functional outcomes following mandibulectomy and fibular free-flap reconstruction

Published:January 02, 2023DOI:https://doi.org/10.1016/j.bjoms.2022.11.287

      Abstract

      There remains a paucity of evidence with regards to functional outcomes following the reconstruction of segmental defects in the mandible. It is, however, well recognised that oral rehabilitation following head and neck surgery is a driver of improved quality of life outcomes. We present a prospective service review of functional outcomes of a consecutive cohort of patients following segmental mandibulectomy and virtual surgical planning (VSP) composite fibular free-flap reconstruction. Twenty-five patients, who were identified as having a complete dataset with a minimum of 12 months’ follow up, ultimately met the inclusion criteria. Validated functional outcome measures were used primarily to assess speech, diet, and swallowing outcomes. The results demonstrate a decline in both speech and swallowing outcomes at three months postoperatively, with a decline of 37% in the Speech Handicap Index from the preoperative baseline, and a decline of 35% in the MD Anderson Dysphagia Inventory score over the same period. The MD Anderson Dysphagia Inventory score improved at 12 months, whereas the Speech Handicap Index did not. Fundamentally a collaborative approach is required between members of the multidisciplinary team (MDT) to enable optimal patient outcomes.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Camuzard O.
        • Dassonville O.
        • Ettaiche M.
        • et al.
        Primary radical ablative surgery and fibula free-flap reconstruction for T4 oral cavity squamous cell carcinoma with mandibular invasion: oncologic and functional results and their predictive factors.
        Eur Arch Otorhinolaryngol. 2017; 274: 441-449
        • Kerawala C.
        • Roques T.
        • Jeannon J.P.
        • et al.
        Oral cavity and lip cancer: United Kingdom national multidisciplinary guidelines.
        J Laryngol Otol. 2016; 130: S83-S89
        • Macpherson L.M.
        Raising awareness of oral cancer from a public and health professional perspective.
        Br Dent J. 2018; 225: 809-814
        • Brown J.S.
        • Lowe D.
        • Kanatas A.
        • et al.
        Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years.
        Br J Oral Maxillofac Surg. 2017; 55: 113-126
        • Rogers S.N.
        • Devine J.
        • Lowe D.
        • et al.
        Longitudinal health-related quality of life after mandibular resection for oral cancer: a comparison between rim and segment.
        Head Neck. 2004; 26: 54-62
        • Barr M.L.
        • Haveles C.S.
        • Rezzadeh K.S.
        • et al.
        Virtual surgical planning for mandibular reconstruction with the fibula free flap: a systematic review and meta-analysis.
        Ann Plast Surg. 2020; 84: 117-122
        • Karnell L.H.
        • Funk G.F.
        • Hoffman H.T.
        Assessing head and neck cancer patient outcome domains.
        Head Neck. 2000; 22: 6-11
      1. American Joint Committee on Cancer and International Union for Cancer Control. AJCC cancer staging manual. 7th ed. Springer, 2010.

        • Chen P.C.
        • Chuang C.H.
        • Leong C.P.
        • et al.
        Systematic review and meta-analysis of the diagnostic accuracy of the water swallow test for screening aspiration in stroke patients.
        J Adv Nurs. 2016; 72: 2575-2586
        • List M.A.
        • Ritter-Sterr C.
        • Lansky S.B.
        A performance status scale for head and neck cancer patients.
        Cancer. 1990; 66: 564-569
        • Chen A.Y.
        • Frankowski R.
        • Bishop-Leone J.
        • et al.
        The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory.
        Arch Otolaryngol Head Neck Surg. 2001; 127: 870-876
        • Rinkel R.N.
        • Verdonck-de Leeuw I.M.
        • van Reij E.J.
        • et al.
        Speech Handicap Index in patients with oral and pharyngeal cancer: better understanding of patients' complaints.
        Head Neck. 2008; 30: 868-874
        • Dawson C.
        • Al-Qamachi L.
        • Martin T.
        Speech and swallowing outcomes following oral cavity reconstruction.
        Curr Opin Otolaryngol Head Neck Surg. 2017; 25: 200-204
        • Pedersen A.
        • Wilson J.
        • McColl E.
        • et al.
        Swallowing outcome measures in head and neck cancer–how do they compare?.
        Oral Oncol. 2016; 52: 104-108
        • Fattori B.
        • Giusti P.
        • Mancini V.
        • et al.
        Comparison between videofluoroscopy, fiberoptic endoscopy and scintigraphy for diagnosis of oro-pharyngeal dysphagia.
        Acta Otorhinolaryngol Ital. 2016; 36: 395-402
        • Zuydam A.C.
        • Rogers S.N.
        • Grayson K.
        • et al.
        Routine use of swallowing outcome measures following head and neck cancer in a multidisciplinary clinic setting.
        Int Arch Otorhinolaryngol. 2021; 25: e185-e192
        • Patterson J.M.
        • McColl E.
        • Carding P.N.
        • et al.
        Swallowing performance in patients with head and neck cancer: a simple clinical test.
        Oral Oncol. 2009; 45: 904-907