Functional rehabilitation in advanced intraoral cancer

Modern treatment of advanced intraoral cancer involves multidisciplinary teams with use of complicated reconstructive techniques to provide improved survival with optimal rehabilitation. Mastication is an important part of this process, and it can be severely impaired by tumor ablation. Whether flap reconstruction is a determinant factor in dental rehabilitation is still in debate.

Thirty-five patients with advanced intraoral cancer were reviewed to determine dental rehabilitation of different reconstructive techniques. The patients were treated with a multidisciplinary team approach. The patients' demographics, primary treatment, reconstructive surgery, dental rehabilitation, and functional outcome were recorded and analyzed.

Nine patients had Stadium III disease, and 26 patients had stadium IV. Thirty-two patients (91.42%) received postoperative radiotherapy. Masticatory and dental functional rehabilitation of patients was very poor. Only 15 patients (42.86%) could eat a normal diet, whereas 18 patients (51.42%) could manage only soft diets, and 2 patients (5.72%) could only be fed with a liquid diet. Denture rehabilitation was even more frustrating and had a direct impact on masticatory rehabilitation. Only 10 patients (28.57%) could use dentures postoperatively and 40% of patients (14 patients) could not use any denture at all. Above all reconstructive techniques, the free radial forearm flap provides the best functional outcome.

Reconstruction of advanced intraoral cancer results in poor denture rehabilitation, especially when bulky flaps are used. If massive resections are necessary, the free radial forearm flap reconstruction provides the best functional outcome.