Quality of Life Outcomes after Free Fibula Flap Reconstruction of Mandibular Defects: A Longitudinal Examination

Abstract

Background A comprehensive understanding of changes in health-related quality of life after head and neck cancer surgery is necessary for effective pre-operative counseling. The goal of this study was to perform a longitudinal analysis of postoperative quality of life outcomes after fibula free flap (FFF) mandible reconstruction. Methods A retrospective review was performed for all patients who underwent oncologic mandible reconstruction with a FFF between 2000 – 2021. Completion of at least one postoperative FACE-Q questionnaire was necessary for inclusion. FACE-Q scores were divided into five time periods for analysis. Functional outcomes measured with speech language pathology (SLP) assessments and tracheostomy and gastrostomy tube status were analyzed at three timepoints. Results 109 patients were included. 68 of these patients also had at least one SLP assessment. All outcomes as measured by the various FACE-Q scales did not improve significantly from the immediate postoperative timepoint to the last evaluated timepoint (p>0.05). SLP functional outcomes showed some deterioration over time, but these were not significant (p>0.05). The percentage of patients who required a tracheostomy (18% to 2%, p=0.002) or gastrostomy tube (25% to 11%, p=0.035) decreased significantly from the immediate postoperative timepoint to the last evaluated timepoint. Conclusion Subjective quality of life outcomes do not change significantly with time after oncologic FFF mandible reconstruction. Reconstructive surgeons can use these results to help patients establish appropriate and achievable quality of life goals after surgery. Further studies are warranted to elucidate the impact of specific relevant clinical variables on postoperative quality of life.