D115. Patient Reported Outcomes after Soft Tissue Vs. Bony Free Flap Reconstruction of Mandible Defects

Abstract

PURPOSE: Patient reported outcome measures in oncologic head and neck reconstruction have yet to be fully evaluated. Complex oncologic mandibulectomy reconstructions include bony and/or soft tissue elements. While previous studies evaluated complications and functional results, this study compares FACE-Q scores in patients reconstructed with bony vs. soft tissue free flaps for mandibulectomy defects. METHODS: Patients who underwent mandibulectomy reconstruction with a soft tissue or bony free flap between 2000-2022 and completed at least one postoperative FACE-Q were retrospectively reviewed. FACE-Q responses were divided into functional and stress domains scored from 0-100 (higher scores represent better outcomes). FACE-Q scores were compared by postoperative period (0-1 year and >1 year), and by mandibulectomy type (lateral and hemi-mandibulectomy). RESULTS: 179 patients underwent mandible reconstruction with a bony flap, and 135 patients received a soft tissue flap. 74 bony and 23 soft tissue flap patients filled out at least one postoperative FACE-Q. Bony flap patients reported significantly greater overall and >1 year satisfaction with their swallowing (p=0.031, p=0.005, respectively) and speaking (p=0.016; p=0.016) function. When reconstructing hemi-mandibulectomy defects, bony flaps also performed significantly better with swallowing (p=0.027) and speaking (p=0.035) function. There was no difference in FACE-Q scores for lateral mandibulectomy defects. CONCLUSION: A preliminary analysis of FACE-Q outcomes for mandibulectomy reconstruction found that bony free flaps may perform better than soft tissue flaps in the speaking and swallowing domains. Expanded cohort studies with longer follow-up could yield valuable information for surgeons considering flap tissue types based on size and location for mandible reconstruction.