Functional Outcome Predictors following Mandibular Reconstruction with Free Fibula Flap, Clinical and Videofluoroscopic Correlation

Abstract

Objectives: Identify outcome predictors by correlating clinical variables with postoperative videofluoroscopic swallow study (VFSS). Methods: Retrospective chart review of 36 patients treated at an academic tertiary center between September 2009 and November 2012. Results: Fifteen females and 21 males with a mean age of 54 years (range 7-81); 17 cases were treated for malignancy. Tongue resection was grouped in 4 categories: no resection (n=6, 16.7%); 0-25% (n=19, 52.8%); 25-50% (n=7, 19.4%) and 50% or more (n=4, 11.1%). The mandibular defect was classified by HCL classification: H (n=6,16.7%); HC (n=2, 5.6%); L (n=8, 22.2%); LC (n=10, 27.8%); LCL (n=10, 27.8%). The size of the bony defect ranged from 3-15cm (mean=9 cm). The flap was osseous only in 10 cases; the cutaneous paddle ranged from 10-125 cm2 (mean=52). A gastrostomy tube was present preoperatively in 8 cases, and postoperatively at least transitorily in 14 cases; X-ray tube (XRT) was used in 17 cases. Postoperative VFSS showed penetration in 13 cases and aspiration in 7. Overall, 29 patients (80.6%) achieved unrestricted diet and this was statistically correlated with: age (p=0.04); XRT (p=0.01); Preoperative G-tube (p=0.12) and penetration or aspiration on VFSS (p=0.01). Conclusions: Age, radiation treatment, preoperative G-tube dependency, and abnormal postoperative swallowing study are predictors for poor functional outcome in patients undergoing mandibular reconstruction with a free fibula flap. Skin paddle size and defect extension/location were not correlated with swallowing outcomes.