Clinical outcome and patient satisfaction after mandibular reconstruction with free fibula flaps

This study evaluated the difference between female and male patients' perception of functional and aesthetic outcomes after mandibular reconstruction with free fibular flaps, the transplant of choice for defects exceeding the length of half a mandible or the simultaneous covering of a soft-tissue defect. Based on clinical records, 54 patients with a mean postoperative follow up of 63 months were reviewed retrospectively. In addition, each patient completed a 12-item scaled questionnaire to assess perception of pain, speech, mastication and deglutition on recipient site, as well as pain, oedema, gait disturbances, difficulties in going upstairs and spraining on donor site. Functional scores on mastication were low for both sexes. The male group showed a higher rating of permanent or frequent difficulties in deglutition and speech. Aesthetic outcome for the recipient region was judged as poor by 62% of the female and 34% of the male patients. Donor site morbidity was described as mild by both sexes with excellent cosmetic results. The perception of facial changes appears to be impacted by gender. Female patients view the aesthetic results of mandibular reconstruction more negatively than do men, but express greater satisfaction with functional outcome. Objective clinician-rated measurements of the donor and recipient region do not always correlate with patient perception of outcome.