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Use of the fixed mandibular implant in oral cancer patients: a retrospective study
1Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston 02114, USA.
Purpose:
A retrospective review of the fixed mandibular implant (FMI) in oral cancer patients is presented. Success of the device and associated complications are discussed.
Patients And Methods:
Eighteen oral cancer patients with an FMI were identified. All were treated at a single institution. Information was obtained from medical records, radiographs, and recall examination. Demographic data, surgical history, prosthesis design, and functional data were analyzed. Results were statistically compared with outcome data for the FMI in noncancer controls.
Results:
The average patient age was 64 years. Seventeen of the 18 patients had squamous cell carcinoma, most being T3 or T4 lesions at diagnosis. Four of 18 patients received radiation therapy (XRT) followed by resection, 11 had resection followed by XRT, two had XRT alone, and one had surgery alone. The average XRT dose to the mandible was 65.4 Gy. Two of the patients received hyperbaric oxygen (HBO). Sixteen of the implants had been loaded and followed an average of 16.4 months. Early complications included soft tissue overgrowth around pins (4 of 18); tongue ulceration (2 of 18), and intraoral wound dehiscence (2 of 18). Late complications included fistula formation (3 of 18); submental erythema (2 of 18), and persistent tissue overgrowth around pins (1 of 19). No complications required removal of the implant. Only the rate of fistula formation was statistically greater than in controls (P = .005). Average time between FMI placement and prosthesis delivery was 3.6 months. Fourteen of the 16 patients with a prosthesis reported improved ability to eat solid foods and improved articulation. All 16 patients reported improved aesthetics and increased comfort in social settings.
Conclusions:
The FMI is a valuable device for dental rehabilitation in oral cancer patients. Success was shown in radiated patients. The complication rate is acceptable, and stability was shown over the follow-up period. Rapid rehabilitation and functional and aesthetic improvements were also reported.