Functional outcome and quality of life after a maxillectomy: a comparison between an implant supported obturator and implant supported fixed prostheses in a free vascularized flap

Abstract

Objective: Defects of the maxilla caused by tumor resection create high levels of psychological and physical trauma for patients. The application of osseointegrated dental implants using either an obturator prosthesis or a free vascularized flap has tremendously changed the retention and stability of the superstructure. However, no study has been performed to compare the function of the aforementioned two approaches and the quality of life using the subjective assessments of patients. Materials and methods: Eligible patients who were treated with maxillary resection and rehabilitated with implant supported obturator prostheses (group 1) or those who received free vascularized flap transfers with implant supported fixed prostheses (group 2) were enrolled between March 2006 and May 2014. A questionnaire that included the indices of the Obturator Functioning Scale (OFS), EORTC Head and Neck 35 assessment and the Mental Health Inventory (MHI) was used to evaluate the functional rehabilitation and QOL of patients in the study. Results: A total of 42 dental implants, including 25 zygomatic implants, were used in 18 patients (mean age: 56.2 ± 12.3 years) in the obturator prostheses in group 1. Twenty patients (mean age: 45.6 ± 14.1 years) who were treated with a vascularized free flap including the fibula (n = 15) and ilium (n = 5) combined with a total of 71 regular implants for fixed prostheses comprised group 2. No statistically significant median differences in the OFS, EORTC Head and Neck assessment and MHI global scale were observed between the groups. On the MHI subscales item-levels, higher median subscale scores exhibited by group 1 than group 2 and had statistically significant difference between the groups (P = 0.024). Conclusion: Within the limitations of this study, it demonstrated no difference in oral function between patients with implant supported obturators and implant supported fixed prostheses in free vascularized flaps after a maxillectomy. However, patients who received obturator therapy seemed to have poorer mental health than did patients with fixed prostheses, but it should be interpreted prudently with the study's limitation.