Masticatory performance in patients undergoing free fibula flap for mandible reconstruction

Abstract

Background To explore the masticatory performance in patients undergoing an osteo(cutaneous) free fibula (OFF) flap for mandible reconstruction by a prospective design. Methods A total of 56 patients who had undergone OFF flap reconstructions for mandibular reconstruction secondary to malignant (squamous cell carcinoma) or benign (ameloblastoma) tumor resection were prospectively enrolled. They were asked to complete the masticatory performance test by the weigh method and the chew domain of the University of Washington quality of life questionnaire (version 4) preoperatively and at 3, 6, and 12 months postoperatively. The pair nonparametric test was used to analyze the dynamic change of masticatory performance and subjective chew function. Results Fifty-one patients were included for analysis finally. The mean masticatory performance for patients with malignant tumors were 53.4% ± 10.3%, 36.4% ± 10.3%, 42.6% ± 9.6%, 52.8% ± 10.9%, and 53.1% ± 11.8% preoperatively, at 2 weeks, 3 months, 6 months, and 12 months postoperatively, respectively. Compared with the preoperative level, the masticatory performance had a significant reduction immediately after surgery (p < 0.001), followed by a return to the baseline level within three months. A similar trend was noted for those with benign tumors. The mean score of chew domain for patients with malignant tumors were 100 ± 0, 54.3 ± 32.9, 81.4 ± 24.5, and 92.9 ± 17.8 preoperatively, at 3 months, 6 months, and 12 months postoperatively, respectively. Compared with the preoperative level, the subjective chew function was greatly affected within the first three months (p < 0.001), and it gradually recovered to the baseline level in the following nine months. A similar trend was noted in patients with benign tumors. Conclusions The masticatory performance and subjective chew function was significantly affected after OFF flap reconstructions in the short term, but both recovered to the preoperative levels within 9–12 months.

Planning of physiotherapeutic procedure in patients after mandible reconstruction taking into account donor site: a literature review

“… Valentini et al (2018) [ 55 ] Desmoid fibromatosis, myxoid fibroma, chondroblastic OS, FD, fibromatosis, rhabdomyosarcoma, OF, CGCG, AB, KCOT, OS, plexiform sarcoma, gunshot, melanocytic neuroectodermal tumor, ES, mucoepidermoid carcinoma n = 25 age 0–18 FFF, ICFF, latissimus dorsi free flap, rib graft, local flap, scapula free flap, rectus abdominis free flap, temporalis flap Good phonation and swallowing, normal or good oral function 22. Zhang J et al [ 25 ] SCC, AB n = 56 age 31–65 FFF Temporary deterioration of chewing performance in the examination and in the patients’ evaluation 23. Zhu et al [ 57 ] FD n = 1 age 30 FFF No damage to facial function …”

“…The results indicated a significant improvement in bite strength, however, the publication does not specify the measuring tool that was used to conduct the study. Chewing performance was also investigated in a relatively objective manner in the Zhang et al [ 25 ] study. Patients underwent a Masticatory performance test consisting of chewing 5 g of peanuts, rinsing the mouth, spitting its contents into a measuring cylinder, and then sifting through a mesh with 2 mm holes.…”

“…Based on the weight of the food residues on the mesh, the result of chewing efficiency was given as a percentage and indicated a significant deterioration in chewing performance after the procedure. In the same study, patients were also asked to subjectively assess chewing sensations using the University of Washington quality of life questionnaire [ 25 ]. It also confirmed a significant deterioration in chewing function.…”

Oral rehabilitation and associated quality of life following mandibular reconstruction with free fibula flap: a cross-sectional study

“…Mandibular reconstruction with the free fibula flap (FFF) is the gold standard for bridging mandibular continuity defects of nearly any extent and cause, since it was first described by Hidalgo (1,2), and is nowadays performed highly standardized (3)(4)(5). But despite the overall good healing rates of the FFF for mandibular reconstruction, the frequency of dental implant placement is only around 30%, as Brown et al pointed out in their meta-analysis (6).…”