883P - Oral rehabilitation after mandibular reconstruction for head and neck malignancy: A multicenter study

Background

Mandibular bone resection is indicated in case of bone invasion or close contact with the tumor. The microvascular bone free flap (MBFP) is the reconstruction of choice. Despite a higher risk of complications, it allows oral rehabilitation. However, many patients do not benefit from it. We sought to assess the rate of non-rehabilitated patients and the reasons why.

Methods

This multicenter study was carried out in 6 centers in France. Patients were included if treated between January 2017 and January 2022 for head and neck carcinoma with MBFP. Patients who had relapsed or died were excluded. Included patients completed a telephone questionnaire.

Results

Of the 175 identified patients, 104 patients were finally included. Median follow-up since initial surgery was 26 months (min 18-max 60 months). MBFP consisted of a fibular free flap in 83% of cases, a scapular free flap in 16% of cases and an iliac crest free flap in 1% of cases. 61 patients (59%) had no oral rehabilitation. 17% of these patients had never been informed of the possibilities of oral rehabilitation, and 20% of these patients had never met any oral rehabilitation specialist. 22% of patients had an unsuccessful attempt at oral rehabilitation (removable prosthesis or implant-supported prosthesis). Of the 43 rehabilitated patients, 81% had a removable prosthesis and 19% an implant-supported prosthesis. Neither the number of osteotomies, nor the complexity of the reconstruction, nor the pre- or post-operative history of radiotherapy, nor the use of cutting guides were statistically associated with oral rehabilitation in this series. Only the presence of an oral rehabilitation specialist in the center had a significant influence on the rehabilitation rate (p=0.004), irrespective of the surgeon's specialty.

Conclusions

This is the first multicenter study to evaluate the rate of oral rehabilitation after free bone flap reconstruction for malignancy. Only 41% of patients benefited from rehabilitation. Regardless of the complexity of the reconstruction, the only factor influencing oral rehabilitation was the presence of an oral rehabilitation specialist in the center.

Clinical trial identification

Editorial acknowledgement

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.