Abstract
Introduction:Squamous cell carcinoma of the oral cavity is the most common cause of mandibular defect. The functional and aesthetic impacts of this surgery must be considered. The number of mandibular resections depends on the TNM classification of the tumor. Mandibular reconstruction by a fibula free flap has become the gold standard. Unfortunately, not all mandibular resections are rehabilitated. The purpose of this study is to evaluate oral rehabilitation after mandibular resection in patients with squamous cell carcinoma.Materials and methods:A retrospective study was conducted to evaluate oral rehabilitations according to the type of surgical resection and reconstruction. The secondary evaluation criteria were type of rehabilitation, implant success rate, post-radiotherapy delay, rehabilitation success rate, and causes of non-rehabilitation.Results:The study included 157 patients with mandibular resection. Of the patients, 26.7 percent received oral rehabilitation. All rehabilitation with implants was functional. The main causes of non-rehabilitation were death or recurrences related to the progression of the disease, postoperative anatomical difficulties, and cost of oral rehabilitation.Conclusion:Oral rehabilitation after mandibular resection surgery is insufficient. A rehabilitation unit including a maxillofacial surgeon, oral surgeon, and dentist is essential. Implementation of the unit should be considered as soon as possible. The cost of rehabilitation should not be a limiting factor.
Highlights
Squamous cell carcinomas of the oral cavity are the most common cause of mandibular defect [1]
The rate of oral rehabilitation according to the resection surgery was divided as follows (Fig. 1): – Partial mandibulectomy: 20 patients (32%). – Total mandibulectomy reconstructed with a titanium plate: 7 patients (19%)
The type of oral rehabilitation according to the resection surgery was as follows: – Implant rehabilitations (11 patients): fibula flap (6 patients; 10%), titanium plate (3 patients; 8%), partial mandibulectomy (2 patients; 3%). – Prothesis rehabilitations with full or partial dentures (30 patients): fibula flap (8 patients; 13%), titanium plate (4 patients; 11%), partial mandibulectomy (18 patients; 29%)
Summary
Squamous cell carcinomas of the oral cavity are the most common cause of mandibular defect [1]. Surgical reconstruction treatment for mandibular defect has many consequences. Every mandibular defect should receive adequate oral rehabilitation. Since Hidalgo first described the procedure in 1989 [2], reconstruction of a total mandibular defect with a microvascular fibula free flap has become the gold standard [3,4]. It enables oral rehabilitation using intraosseous implants and has an excellent survival rate ranging from 85 to 98 percent [5,6,7]
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