Quality of life after segmental mandibulectomy and free flap for mandibular osteonecrosis: Systematic review

Abstract

ObjectiveReview QOL outcomes among patients undergoing segmental mandibulectomy and bony free flap reconstruction for ONJ. Data sourcesPubMed was searched for MeSH terms “Quality of life,” “Osteonecrosis,” “Osteoradionecrosis,” “Bisphosphonate-associated osteonecrosis of the jaw,” “Free tissue flaps,” and “Mandibular reconstruction.” Review methodsEnglish language studies with QOL outcomes data for patients undergoing free flap reconstruction for advanced ONJ were included. 197 records were initially screened; 18 full texts assessed; 10 full texts included. PRISMA guidelines were followed. ResultsTen studies were included in this systematic review: six retrospective, three retrospective with comparison groups, and one prospective. In studies with comparison groups, ONJ patients have worse self-reported QOL than the general population as well as head and neck cancer patients without ONJ. Nearly all patients with QOL measurements (220/235 patients) had ONJ from prior radiation. Segmental mandibulectomy and bony free flap improved overall QOL in over half of patients, as well as pain associated with ONJ in 70–75 % of patients. Surgery did not improve long-term effects of radiation such as chewing, swallowing, and salivary production. Donor site morbidity rarely affects QOL. ConclusionsOsteonecrosis of the jaw (ONJ) worsens quality-of-life, and advanced disease often requires segmental mandibulectomy and bony free flap reconstruction. Patients and surgeons may expect improvement in some, but not all, domains of patient-reported QOL by the use of segmental mandibulectomy and reconstruction for advanced ONJ.