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. 2019 Jul;41(7):2123-2132.
doi: 10.1002/hed.25666. Epub 2019 Feb 13.

Long-term functional and esthetic outcomes after fibula free flap reconstruction of the mandible

Ivana Petrovic  1 , Raymond Baser  2 , Timothy Blackwell  3 , Colleen McCarthy  4 , Ian Ganly  3 , Snehal Patel  3 , Peter Cordeiro  4 , Jatin Shah  3   5   6
Affiliations

Long-term functional and esthetic outcomes after fibula free flap reconstruction of the mandible

Ivana Petrovic et al. Head Neck. 2019 Jul.

Abstract

Background: The goal of this study is to report functional and esthetic outcomes, after fibula free flap (FFF) reconstruction of the mandible for oral cancer, assessed by physicians, nonclinicians, and patients.

Methods: Twenty-five long-term survivors from oral cancer after FFF reconstruction were recalled for head and neck examination by surgeons, for photographs and patient-reported outcomes, using EORTC, QLQ-C30, H&N35, and FACE-Q questionnaires.

Results: Physicians reported 64% restoration of functionality compared to normal. Patients reported high scores on QLQ-C30 but lower scores on H&N35. Esthetic scores were reported higher by clinicians than nonclinicians. The decline in function and appearance was attributed to loss of lower dentition, trismus, malocclusion, xerostomia, and tissue atrophy.

Conclusion: To minimize the decline in function and appearance, immediate dental implants in FFF, better reconstruction of the temporomandibular joint, newer methods of radiotherapy to minimize xerostomia and oral exercises to prevent trismus should be considered.

Keywords: FACE-Q; QLQ C30; QLQ HN-35; esthetic outcomes; fibula free flap; functional outcomes; head and neck cancer; long-term survivors; malocclusion; oral cancer; patient-reported outcomes; quality of life; trismus; xerostomia.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT: None declared.

Figures

Figure 1.
Figure 1.
Means and 95% Confidence Intervals of Patient-Reported Outcome Measures. Abbreviations: QL = Global health status/QoL; PF = Physical functioning; RF = Role functioning; EF = Emotional functioning; CF = Cognitive functioning; SF = Social functioning; FA = Fatigue; NV = Nausea and vomiting; PA = Pain; DY = Dyspnea; SL = Insomnia; AP = Appetite loss; CO problems; HNSO = Trouble with social eating; HNSC = Trouble with social contact; HNSX = Less sexuality; HNTE = Teeth; HNOM = Opening mouth; HNDR = Dry mouth; HNSS = Sticky saliva; HNCO = Coughing; HNFI = Felt ill
Figure 2.
Figure 2.
Means and 95% Confidence Intervals of Clinician and Non-Clinician Esthetic Ratings of Post-Operative and Current Patient Photographs
Figure 3.
Figure 3.
An extreme example of progressive tissue atrophy
Figure 4.
Figure 4.
Follow-up photographs in non-radiated patient
Figure 5.
Figure 5.
Early post-radiation changes with atrophy and fibrosis
Figure 6.
Figure 6.
Late post-radiation changes with atrophy and fibrosis
See this image and copyright information in PMC

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