Management of the Condyle in Posterior Mandibular Reconstruction: Major Clinical and Patient-Reported Outcomes

Area of Science:

• Oral and Maxillofacial Surgery
• Reconstructive Surgery
• Oncology

Background:

• Posterior mandible tumors often necessitate condyle and soft tissue resection.
• Reconstruction strategies involve condyle preservation or resection with or without autotransplantation.

Purpose of the Study:

• To compare clinical and patient-reported outcomes (PROs) of condyle preservation versus resection in mandibular reconstruction.
• To evaluate the impact of condyle autotransplantation in resected cases.

Main Methods:

• Retrospective cohort study of 94 patients undergoing bony free flap reconstruction for posterolateral mandible defects (2017-2021).
• Clinical outcomes: length of stay, follow-up duration, recurrence, mortality.
• PROs assessed using FACE-Q Head and Neck Cancer module (overall, short-term, long-term).

Main Results:

• No significant differences in major clinical outcomes between cohorts (p > 0.439).
• Condyle preservation group reported superior Overall Facial Appearance, Eating Function, Appearance/Face Distress, Eating Distress, and Cancer Worry compared to condyle resection (p < 0.035).
• Long-term benefits of condyle preservation were more pronounced, especially for appearance, function, and distress (p < 0.035). Condyle autograft did not significantly improve PROs.

Conclusions:

• In-situ condyle preservation leads to superior patient-reported outcomes, particularly long-term, compared to condyle resection with or without autograft.
• Surgical technique choice impacts patient quality of life more than major clinical outcomes.