Quality of Life Assessment in Patients after Mandibular Resection and Free Fibula Flap Reconstruction

Over the past decades, different interventions have been developed to treat patients requiring mandibular resection and reconstruction. Most have presented themselves as viable options, however, not without significant morbidity. There is little information regarding the patient's quality of life after such interventions. In this study we hope to gain better insight into the patient's quality of life after reconstruction of segmental mandibular defects with Free Fibula Flap (FFF).

All patients who underwent segmental mandibular resection and FFF reconstruction at the Division of Oral and Maxillofacial Surgery of McGill University Health Center between July 2008 and February 2011 were included. Patients' medical records were reviewed and analyzed for patients' age and gender, smoking and alcohol consumption, principle diagnosis, ASA status, duration of ICU and hospital stay and post-op complications. Classification of segmental bony defects was based on Urken's system. The size of the resection was estimated from the Panoramic X-ray. Patients were contacted and asked to fill out a Quality of Life (QOL) assessment (University of Washington, v 4) at least one year post surgery. Descriptive analysis was used for data analysis.

Seventeen patients (10 males and 7 females) underwent segmental mandibular resection and reconstruction with FFF. The patients' age at the time of surgery ranged from 15 to 77 years, with a mean age of 52. Ten patients were diagnosed with Squamous Cell Carcinoma, one with Basal Cell Carcinoma, two with Ameloblastoma, one with Myxoma, one with recurrent Giant Cell Granuloma, one with BRONJ and one with Osteoradionecrosis. The ASA status was 2 for eight patients, 3 for seven patients and 4 for two patients. The average time spent in the ICU and hospital was 3.9 and 18.7 days respectively. One flap was lost due to arterial thrombosis. The size of the resection ranged between 7 and 21 cm. Of the seventeen patients who underwent FFF reconstruction, ten patients completed the QOL questionnaire. Two patients were deceased at the time of the study, one refused, one had recurrence and was excluded and three patients are yet to be scheduled. Five out of ten patients who completed the QOL assessment rated their overall quality of life to be outstanding or very good and five other patients reported it to be good or fair. Similarly, five patients rated their health related quality of life as outstanding or very good, three as good and fair and two reported it to be poor. Patients' greatest concern was appearance of the face and neck. Additionally, patients reported reduced saliva and level of activity and rated them among the most important parameters on the QOL assessment. Three out of ten patients reported diminished chewing abilities. Five patients reported no pain and five only mild pain in the face and neck region not requiring medications.

The majority of patients who underwent mandibular resection and FFF reconstruction reported satisfaction with their overall quality of life at one year post surgery.

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