Mandibular reconstructions with local or free flaps: focus on patient’s quality of life

OBJECTIVES: Local or free flap reconstructions have become the gold standard for the treatment of maxillofacial defects mainly related to ablative surgery for head and neck cancer. The reconstruction of large defects requires more invasive surgical treatments and adjunctive radiotherapy or/and chemotherapy.
The aim of this study was to describe the quality of life of patients submitted to mandibular reconstruction using local or free flaps.

MATERIALS AND METHODS: A prospective cohort study was conducted between December 2016 and October 2020. The quality of life was evaluated by using the Italian version of the European Organization for Research and Treatment of Cancer (EORTC), Core QoL Questionnaire (QLQ-C30), EORTC Head and Neck Cancer module, and the 5 level EQ-5D version by the EuroQol Group.
Sociodemographic data were collected such as sex, age, employment status, marital status, educational level, family income status, public financial assistance. Descriptive statistics were used to summarize sample’s characteristics, while the non-parametric Mann-Whitney U-test was applied to test the null hypothesis that sex and employment status did not affect the QoL values according to QLQ-C30, QLQ H&N35 and EQ- 5D-5L before surgery. The Kruskal- Wallis test was used to evaluate the influence of tumor location, pTNM classification, marital status, educational level and family income bracket on QoL at before surgery. The Wilcoxon signedrank test was used to describe the changes in quality of life between a month and six months after surgery respectively. The correlation between flap type, flap and/or donor site complications and systemic complications with the QoL was evaluated through the Kendall rank correlation coefficient at 1-month and 6-months. While the correlation between length of hospitalizations and QoL was studied using the Kendall rank correlation coefficient at 6-months follow-up. The significance level was set to p <0.05.

RESULTS: Twelve head and neck cancer patients were included in the study. All the patients experienced a collapse of the quality of life at 1-month follow-up after flap mandibular reconstruction, while a full recovery was obtained after 6-months from surgery. The main symptoms described a month after surgery were fatigue, swallowing, dry mouth, speech, social contact and feeding tube. Flap and/or donor site complications and systemic complications were more frequently correlated to QoL alterations both at 1-month follow- up and 6-months follow-up. In particular, flap complications
could affect the global health status, fatigue, pain, speech and significantly increase the use of pain killers at a month follow-up. Emotional functioning, social functioning, nausea and vomiting, insomnia, diarrhea symptoms and social eating were mainly correlated to systemic complications at a month follow-up.

CONCLUSIONS: The good QoL outcome and the almost complete remission of symptoms at 6-months follow-up demonstrate the efficacy and reliability of flap reconstructions for mandibular defects.

CLINICAL SIGNIFICANCE: The patient’s quality of life evaluation is an important step for the full management of the patient, especially for invasive procedures such as mandibular defect reconstructions. This evaluation should become common in clinical practice.

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