Functional outcomes after myocutaneous free flap and osteocutaneous free flap for maxillary reconstruction: across sectional comparison

Abstract

Background Maxillary defects subsequent to hemimaxillectomy have long been restored with a pedicled temporalis flap. Recently,the trend towards maxillary reconstruction using vascularized bone free flaps and soft tissue free flaps has been gaining popularity. However, the value in terms of functional rehabilitation of these surgical modalities remains unconclusive.

Objective To ascertain and compare masticatory performance and quality-of-life in patients with surgically reconstructed maxillectomy Class 2 (subtype A) defects by vascularized bone free flaps, vascularized soft tissue free flaps and pedicled soft tissue flaps.

Methods Eighteen patients divided into 3 groups (4 vascularized bone flap, 5 vascularized soft tissue flap, 9 pedicled soft tissue flaps) were evaluated for functional outcome and qualityof-life (QoL). All patients were objectively assessed using masticatory comminution test. Subjective evaluation was conducted using functional outcomes questionnaire and patient reported speech perception. Self image and body perception were assessed using Body Esteem Scale. Overall quality-of-life was assessed using University of Washington QoL questionnaires.

Results Patients reconstructed with vascularized bone flaps and vascularized soft tissue flaps showed superior masticatory performance compared to patients reconstructed with pedicled soft tissue flaps. Speech, facial attractiveness and overall QoL were similar for all three groups.

Conclusions Maxillectomy class 2 (subtype A) patients show comparable speech, facial attractiveness and quality-of-life levels after reconstruction with vascularized bone flaps, vascularized soft tissue flaps and pedicled soft tissue flaps. However, those reconstructed with pedicled soft tissue flaps achieved lowest masticatory performances amongst the three surgical reconstruction modalities. Thus, the choice of recontruction for maxillectomy class 2 (subtype A) defects should be guided by minimizing surgical time and long term morbidity given the apparent similarity in functional outcomes.