Aesthetic and functional outcomes using osseous or soft-tissue free flaps.

Area of Science:

• Oral and Maxillofacial Surgery
• Reconstructive Surgery
• Biomaterials Science

Background:

• Posterior mandible defects require reconstruction to restore function and aesthetics.
• Free flaps containing vascularized bone (VBFs) and soft-tissue flaps (STFs) are surgical options.
• Limited comparative data exists on functional and aesthetic outcomes between VBFs and STFs for posterior mandible reconstruction.

Purpose of the Study:

• To compare functional and aesthetic outcomes of posterior mandible reconstruction using VBFs versus STFs.
• To develop an objective method for evaluating outcomes in posterior mandible reconstruction.
• To assess the impact of reconstruction method on diet, oral competence, speech, and facial symmetry.

Main Methods:

• Retrospective review of 58 posterior mandible reconstructions (32 STFs, 26 VBFs).
• Functional outcomes assessed via patient questionnaires (diet, oral competence, pain, trismus, speech, cosmesis, social reintegration, return to work).
• Aesthetic outcomes evaluated using computer-assisted image analysis of facial proportions and midline symmetry.

Main Results:

• VBFs showed statistically significant improvements in 5/12 functional categories compared to STFs.
• Patients receiving VBFs reported better outcomes in diet (31% vs 21%), oral competence (56% vs 35%), and speech (47% vs 30%).
• VBF reconstruction resulted in superior midline symmetry (3.3mm deviation vs 5.8mm for STFs) and higher rates of return to public dining (72% vs 35%).

Conclusions:

• Posterior mandible reconstruction with VBFs is associated with superior functional and aesthetic outcomes, particularly in speech, diet, and midline symmetry.
• An objective evaluation method for reconstructive outcomes was successfully developed.
• Further research is needed to definitively conclude VBF superiority, considering oropharyngeal defects and radiation therapy protocols.