Effect of Radiotherapy on Functional and Health-Related Quality of Life Outcomes after Jaw Reconstruction

Abstract

Long-term health-related quality of life (HRQOL) and functional outcomes following mandibular and maxillary reconstruction are lacking. To determine these outcomes, a cross-sectional study of patients with a history of cancer who underwent jaw reconstruction was undertaken. Participants were identified from a database of jaw reconstruction procedures at the Chris O’Brien Lifehouse (Sydney, Australia). Eligible patients had at least one month follow-up, were aged ≥18 years at surgery, and had history of malignancy. HRQOL was measured using the FACE-Q Head and Neck Cancer Module (FACE-Q H&N). Functional outcomes were measured using the FACE-Q H&N, MD Anderson Dysphagia Inventory (MDADI) and Speech Handicap Index (SHI). Ninety-seven questionnaires were completed (62% response rate). Mean age of respondents was 63.7 years, 61% were male, and 64% underwent radiotherapy. Treatment with radiotherapy was associated with worse outcomes across 10/14 FACE-Q H&N scales, three MDADI subscales and one composite score, and the SHI. Mean differences in scores between irradiated and non-irradiated patients exceeded clinically meaningful differences for the MDADI and SHI. Issues with oral competence, saliva, speaking, and swallowing worsened with increasing time since surgery. Younger patients reported greater concerns with appearance, smiling, speaking, and cancer worry. Women reported greater concerns regarding appearance and associated distress. History of radiotherapy substantially impacts HRQOL and function after jaw reconstruction. Age at surgery and gender were also predictors of outcomes and associated distress. Pre-treatment counselling of patients requiring jaw reconstruction may lead to improved survivorship for patients with head and neck cancer.

Trends in free flap reconstruction of the head and neck: a single surgeon series of 1027 free tissue transfers

“…First used for complex and re‐operative jaw reconstruction, 18,19 VSP is now routine and has led to several paradigm shifts, especially occlusal‐based planning 20 where the bone is positioned around the preferred endosseous implant locations 20 . VSP has facilitated more rapid dental rehabilitation, improved health‐related quality of life outcomes, 21–23 and bespoke options including the prefabricated fibula, 21 the ‘Alberta’ and ‘Sydney Modified Alberta Reconstruction Technique’, 20,24 and ‘Jaw in a Day’ approaches 25 . More recently, in‐house (point‐of‐care) digital planning and manufacturing has made these dental rehabilitative options even more accessible 26–29 …”

“…This has changed referral patterns and influenced the flap choice in ways that are unlikely to be representative of other tertiary and quaternary referral institutions. They have also used reconstructive approaches that are not routinely employed by all institutions including dynamic facial reanimation using the chimeric VALT, 11,12,33 scapular flaps for osseous reconstruction, 31,32 the SCIP flap for oral reconstruction, 17,34 fascial flaps such as the TPF flap for laryngotracheal reconstruction and osteoradionecrosis, 35–37 and point‐of‐care VSP with primary dental implants for maxillomandibular reconstruction 18–24,26–32,38 …”

“…They have also used reconstructive approaches that are not routinely employed by all institutions including dynamic facial reanimation using the chimeric VALT, 11,12,33 scapular flaps for osseous reconstruction, 31,32 the SCIP flap for oral reconstruction, 17,34 fascial flaps such as the TPF flap for laryngotracheal reconstruction and osteoradionecrosis, [35][36][37] and point-of-care VSP with primary dental implants for maxillomandibular reconstruction. [18][19][20][21][22][23][24][26][27][28][29][30][31][32]38…”

How age affects health‐related‐quality‐of‐life outcomes in maxillomandibular reconstructive surgery

“…Adjuvant radiotherapy is common in oncological maxillomandibular surgery. 41 Typically, in the treatment of head and neck cancer, health related quality of life deteriorates due to radiation therapy. 42 This is primarily due to a series of adverse effects, including dysphagia, xerostomia, scarring and trismus.…”

“…Adjuvant radiotherapy is common in oncological maxillomandibular surgery 41 . Typically, in the treatment of head and neck cancer, health related quality of life deteriorates due to radiation therapy 42 .…”