Comparison of functional and quality-of-life outcomes in patients with and without palatomaxillary reconstruction: a preliminary report.
BACKGROUND
Orodental rehabilitation of hemipalatomaxillectomy defects can be accomplished by using a prosthetic obturator or a vascularized bone-containing free flap. Whereas prosthetic obturation offers several advantages, including the opportunity for immediate dental restoration without the need for further surgery, vascularized bone grafts provide permanent closure of the oronasal communication and bone sufficient for the placement of osseointegrated implants.


OBJECTIVE
To compare the functional and quality-of-life (QOL) outcomes in patients rehabilitated with a prosthetic obturator with defect-matched patients who underwent reconstruction with a vascularized bone-containing free flap.


METHODS
Four hemipalatomaxillectomy patients rehabilitated with a tissue-borne prosthetic obturator were compared with 4 defect-matched hemipalatomaxillectomy patients who underwent reconstruction with a vascularized bone-containing free flap. All of the patients were objectively assessed for speech, mastication, and QOL. Functional status was assessed by mastication testing, voice analysis, and nasorhinometry. Swallowing-related QOL was assessed using a patient-reported, validated swallowing QOL questionnaire, and donor site morbidity was assessed using upper extremity and lower extremity questionnaires.


RESULTS
Patients who underwent reconstruction with a vascularized bone-containing free flap achieved higher mastication and speech assessment scores with less oronasal reflux than defect-matched patients rehabilitated with a prosthetic obturator. Swallowing QOL and donor site assessments demonstrated that compared with their prosthetic counterparts, reconstruction patients enjoyed a better QOL without incurring significant donor site morbidity.


CONCLUSIONS
Although palatomaxillary reconstruction with vascularized bone-containing free flaps requires a second operative site, this method of orodental rehabilitation of the hemipalatomaxillectomy defect can achieve superior functional and QOL outcomes relative to defect-matched patients rehabilitated with a prosthetic obturator.
Genden
Eric M
EM
Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA. eric.genden@mssm.edu
Okay
Devin
D
Stepp
Marita T
MT
Rezaee
Rod P
RP
Mojica
Jacqueline S
JS
Buchbinder
Daniel
D
Urken
Mark L
ML
D006801:Humans; D008409:Mastication; D008437:Maxilla / Q000601:surgery*; D008447:Maxillofacial Prosthesis; D010158:Palatal Obturators; D011788:Quality of Life; D013065:Speech Intelligibility; D013067:Speech Perception; D013524:Surgical Flaps; D016896:Treatment Outcome