Oral rehabilitation after mandibular reconstruction using an osteocutaneous fibula free flap with endosseous implants. Factors affecting the functional outcome in patients with oral cancer.
BACKGROUND
The development of endosseous implants and free vascularized bone grafting has permitted increased possibilities of oromandibular reconstruction in patients with oral cancer. In this study, a concept combining surgical and prosthodontic treatments for mandibular fibula free flap reconstruction after tumor surgery was made based on a classification of bone defects. A follow-up study was performed to evaluate the treatment concept for oral rehabilitation in order to identify possible factors which may influence the functional result.


METHODS
A follow-up examination included 28 patients who underwent the ablative tumor surgery and mandibular reconstruction during a 4-year period. The follow-up protocol included clinical examination, radiological evaluation, and an interview using a standardized questionnaire. The timing of the study was set to allow for a minimum 2-year follow-up (mean 45 months).


CONCLUSIONS
At the time of examination, prosthesis-based oral rehabilitation was completed in six patients (21%), and the prosthodontic work was still unfinished in four other patients. The other 18 had no dental prosthetic rehabilitation. Thirteen patients received a total of 37 oral implants, and 23 implants were functionally loaded. No implant loss was recorded. Oral functions such as speech, diet tolerance and oral competence were not directly affected by the presence of dentures. A decisive factor affecting the oral function was the extent of soft-tissue loss. According to the classification described here, the extent of the mandibular defect did not correlate with oral functions. The application of oral implants seemed to be advantageous for the oral rehabilitation of patients who had undergone intraoral resections.
Iizuka
Tateyuki
T
Department of Cranio-Maxillofacial Surgery, University of Berne, Inselspital CH-3010 Berne, Switzerland. tateyuki.iizuka@insel.ch
Häfliger
Jörg
J
Seto
Ichiro
I
Rahal
Akram
A
Mericske-Stern
Regina
R
Smolka
Koord
K
D016025:Bone Transplantation / Q000379:methods; D003679:Deglutition; D003758:Dental Implantation, Endosseous; D019094:Dental Prosthesis, Implant-Supported; D004032:Diet; D005260:Female; D005360:Fibula; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008334:Mandible / Q000473:pathology / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000532:radiotherapy / Q000534:rehabilitation* / Q000601:surgery; D008341:Mandibular Prosthesis; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000145:classification; D010027:Osteotomy / Q000145:classification; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000145:classification; D012798:Sialorrhea; D013065:Speech Intelligibility; D013524:Surgical Flaps / Q000145:classification; D016896:Treatment Outcome