S Atallah1, A Bozec2, P Ransy3, J Davrou4, J Longis5, M Humbert6, E Brenet7, P Schultz8, A Damecourt9, J Lacau Saint Guily1, B Baujat10. 1. Sorbonne Université, Hôpital Tenon, Service d'ORL et Chirurgie Cervico-Faciale, AP-HP, 4, rue de la Chine, 75020 Paris, France. 2. Centre Antoine Lacassagne, département d'ORL et de chirurgie carcinologique de la Tête et du Cou, 33, avenue de Valombrose, 06189 Nice, France. 3. Service ORL et de chirurgie cervico-faciale, CHU Sart Tilman, Liège, Belgium. 4. Université Picardie Jules-Verne, CHRU, service de chirurgie maxillo-faciale et stomatologie, Place Victor Pauchet, 80054 Amiens Cedex, France. 5. Clinique de chirurgie maxillo-faciale et stomatologie, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France. 6. Service d'ORL, CHU Côte de Nacre/Centre François Baclesse, Service du Dr MY Louis, Caen, France. 7. CHU de Reims, Hôpital Robert Debré, Service ORL et Chirurgie Cervico-faciale, Reims, France. 8. Service ORL et Chirurgie Cervico-Faciale, CHU Hautepierre, 1 Avenue Maline, 67098 Strasbourg, France. 9. Service d'ORL, CHU Gui de Chauliac, Montpellier, France. 10. Sorbonne Université, Hôpital Tenon, Service d'ORL et Chirurgie Cervico-Faciale, AP-HP, 4, rue de la Chine, 75020 Paris, France. Electronic address: Bertrand.baujat@aphp.fr.
Abstract
OBJECTIVES: To assess the functional results of oromandibular reconstruction by free bone flap, in terms of swallowing, speech and esthetics. MATERIALS AND METHODS: A transverse multicenter study included 134 patients reconstructed by free bone flap between 1998 and 2016, with more than 6 months' follow-up, in 9 centers. A standardized questionnaire collected data on patients and treatment. Study endpoints comprised: weight loss, mouth opening, gastrostomy dependence, type of feeding, and DHI score. The impact of patient baseline characteristics on these functional criteria was explored by uni/multivariate analysis. RESULTS: Ninety of the 134 patients had cancer. Fibula flap was mainly used (80%). 94% of reconstructions were primary successes. 71% of patients had pre- or post-operative radiation therapy. 88% had less than 50% lingual resection. 97% recovered oral feeding. 89% had intelligible speech. 86% judged their esthetic appearance as good/average. 9% had dental prosthetic rehabilitation. Radiation therapy and extensive lingual resection significantly impacted swallowing function (P=0.04 and P=0.03, respectively). Radiation therapy and oropharyngeal extension significantly increased gastrostomy dependence (P=0.04 and P=0.02, respectively). CONCLUSION: Oromandibular reconstruction by free bone flap enabled return to oral feeding in most cases. More than 80% of patients were satisfied with their result in terms of speech and esthetics. However, the rate of dental rehabilitation was low and the rate of complications was high.
OBJECTIVES: To assess the functional results of oromandibular reconstruction by free bone flap, in terms of swallowing, speech and esthetics. MATERIALS AND METHODS: A transverse multicenter study included 134 patients reconstructed by free bone flap between 1998 and 2016, with more than 6 months' follow-up, in 9 centers. A standardized questionnaire collected data on patients and treatment. Study endpoints comprised: weight loss, mouth opening, gastrostomy dependence, type of feeding, and DHI score. The impact of patient baseline characteristics on these functional criteria was explored by uni/multivariate analysis. RESULTS: Ninety of the 134 patients had cancer. Fibula flap was mainly used (80%). 94% of reconstructions were primary successes. 71% of patients had pre- or post-operative radiation therapy. 88% had less than 50% lingual resection. 97% recovered oral feeding. 89% had intelligible speech. 86% judged their esthetic appearance as good/average. 9% had dental prosthetic rehabilitation. Radiation therapy and extensive lingual resection significantly impacted swallowing function (P=0.04 and P=0.03, respectively). Radiation therapy and oropharyngeal extension significantly increased gastrostomy dependence (P=0.04 and P=0.02, respectively). CONCLUSION: Oromandibular reconstruction by free bone flap enabled return to oral feeding in most cases. More than 80% of patients were satisfied with their result in terms of speech and esthetics. However, the rate of dental rehabilitation was low and the rate of complications was high.
Authors: Sabah Falek; Rajesh Regmi; Joel Herault; Melanie Dore; Anthony Vela; Pauline Dutheil; Cyril Moignier; Pierre-Yves Marcy; Julien Drouet; Arnaud Beddok; Noah E Letwin; Joel Epstein; Upendra Parvathaneni; Juliette Thariat Journal: Support Care Cancer Date: 2022-05-05 Impact factor: 3.359