Quality of life in patients undergoing segmental mandibular resection and staged reconstruction with nonvascularized bone grafts.
OBJECTIVE
The treatment of locally aggressive lesions of the mandible can have a profound effect on a patient's quality of life (QOL), both functionally and psychologically. The more knowledge available on this subject, the better a patient can be prepared and counseled.


METHODS
Patients undergoing mandibular resection with immediate insertion of a reconstruction plate and subsequent staged reconstruction for the management of locally aggressive lesions of the mandible at the University of California at San Francisco were studied over a 6-year period from 1999 to 2005. The staged reconstruction involved bone grafting, removal of the reconstruction plate, vestibuloplasty, implant insertion, and construction of an implant-supported prosthesis. Each patient completed a modified University of Washington Quality of Life version 4 questionnaire after reaching his or her highest level of reconstruction.


RESULTS
A total of 26 patients were identified as fulfilling the criteria for this study. Eight patients did not progress beyond resection, bone grafting, and subsequent removal of the bone plate. Seven patients progressed all the way through the 7 stages to an implant-supported prosthesis. The most important determinants of the patient's subsequent QOL were time interval from initial resection and stage of reconstruction; the greater the time interval from initial resection and the further the stage of reconstruction reached, the better the QOL. Resections involving the mandibular angle had a negative effect on appearance, and resections involving the parasymphysis and symphysis region carried a worse overall QOL, possibly due to difficulty with chewing and lip support. Males reached a higher overall QOL than females. Although most patients seemed satisfied with their overall QOL, 73% had some concerns regarding appearance, 42% had concerns with chewing, 42% had concerns regarding their mood, 35% felt more anxious since the surgery, 23% had some residual pain and discomfort, 19% had concerns with swallowing, and 15% had concerns with taste.


CONCLUSIONS
These and other findings necessitate further investigation and confirmation.
Young
Carl W
CW
Department of Oral and Maxillofacial Surgery, University of California, San Francisco, San Francisco, CA 94143-0440, USA.
Pogrel
M Anthony
MA
Schmidt
Brian L
BL
D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D016009:Chi-Square Distribution; D002648:Child; D019094:Dental Prosthesis, Implant-Supported / Q000523:psychology; D004955:Esthetics, Dental / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000523:psychology / Q000601:surgery*; D008341:Mandibular Prosthesis / Q000523:psychology; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000523:psychology*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000523:psychology*; D020127:Recovery of Function; D012737:Sex Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires