A pilot study of masticatory function after maxillectomy comparing rehabilitation with an obturator prosthesis and reconstruction with a digitally planned, prefabricated, free, vascularized fibula flap

Abstract

STATEMENT OF PROBLEM: Oral rehabilitation after maxillectomy can be performed by prosthetic obturation or with a free fibula flap. Successful prosthetic obturation of large maxillectomy defects can be difficult, and masticatory function is at risk in these patients. Surgical reconstruction might provide adequate masticatory function, but the literature is lacking evidence regarding this topic. PURPOSE: The purpose of this pilot clinical study was to assess masticatory functions and health-related quality of life (HR-QoL) outcomes in patients after maxillectomy reconstructed by using the Rohner or the Alberta Reconstructive Technique and to compare outcomes with patients rehabilitated with an obturator prosthesis. MATERIAL AND METHODS: Mixing ability, maximum occlusal force, maximum mouth opening, and HR-QoL were assessed. Differences between the 2 groups were analyzed by using the Kruskal-Wallis tests for continuous variables and chi-squared tests for categorical variables. RESULTS: The reconstructed patients (n=11) showed better mixing ability, occlusal force (nonoperated side), and overall mean HR-QoL. The nonreconstructed group (n=13) did not differ from the reconstructed groups in terms of maximum mouth opening, overall mean occlusal force, occlusal force on the operated side, and most HR-QoL questionnaire domains. CONCLUSIONS: Maxillary reconstruction might be beneficial for masticatory performance in patients undergoing maxillectomy. A larger study is justified to support the possible benefit of the reconstruction of maxillary defects regarding mixing ability, occlusal force (nonoperated side), and HR-QoL.