Major Neck Research Articles

Usage of antimicrobials in patients having intricate clean-contaminated head and neck surgeries.

Objective: The goal of this study is to characterize, the infectious complications and to identify the risk variables most frequently linked, after head and neck surgeries.Methodology: 47 patients who underwent major clean-contaminated head and neck surgery between 2019 and 2022 at the cervicomaxillofacial Surgery Department (Saint-Pierre Hospital) were the subject of a prospective cohort analysis. Two groups of patients were created: group I received a postoperative antibiotic regimen for just 24 hours; group II re-ceived a longer postoperative antibiotic course lasting more than 24 hours. Amoxicillin and clavulanate were given intra-venously 30 to 60 minutes before making the incision as antibacterial precautions. Following surgery, the antibiotic course was maintained. Univariate analysis was used to assess the predictive importance of the antibiotic regimen on postoperative outcomes, including clinical symptoms of infection and biological indicators like the white blood cell count and C-reactive protein levels was evaluated using univariate analysis.Results: 18 patients experienced SSIs. Antibiotics were used to treat each of these grade 2 illnesses. Only a history of hypothyroidism appears to be a predictor of SSI after univariate analysis (P = 0.038). When we compared the patients who received antibiotics for 24 h or more, there was no discernible difference in terms of onset and hospital stay. Addi-tionally, neither group had a different rate of germs that were multidrug resistant.Conclusion: Our findings imply that using postoperative antibiotics for more than 24 hours has no positive effects on SSI.
 Key words: Cervico-maxillofacial Surgery, clean contaminated surgery, antimicrobials, Surgical Site Infection.

Elective Revision Surgery in Head and Neck Cancer Patients: A Retrospective Analysis at an Oncology Centre in Porto, Portugal.

Introduction Elective revision surgery in head and neck cancer is crucial for refining and optimizing outcomes, ensuring complete tumor removal, and enhancing both functional and aesthetic aspects, ultimately improving the overall quality of life for patients. The aim of this study is toanalyze the overall survival (OS) of head and neck cancer patients who underwent elective revision surgery with or without adjuvant treatment between 2019 and 2022, reflecting on thepractice between those years in IPO-Porto, Porto, Portugal. Methods This study included 58 patients who underwent 116 major neck surgeries. Multidisciplinary head and neck follow-up records were obtained for every patient. Overall survival and disease-specific survival (DSS) curves were calculated using the Kaplan-Meier method, and statistical significance was determined by the Log-Rank test. We did a retrospective study with an anterograde direction, evaluating the treatments that were previously done by the patients. Results The sample comprised 51 males (87.9%) and seven females (12.1%), with a mean age of 59.02±11.014 years. Head and neck pathology was mostly in the larynx (36.2%). The type of the first surgery was mainly directed to the primary tumor in 62.1% (n=36). In the other 37.9% (n=22), surgery was directed to the primary tumor in association with neck dissection. The type of the second surgery was mainly revision surgery. We found that T4 tumors (HR (hazard ratio)= 10.219, p = 0.006) and hypopharynx tumors(HR = 5.306, p =0.035)were significantly associated with inferior OS. Conclusion In our sample, we found that a T4 and a tumor located in the hypopharynxwere significantly associated with inferior OS in elective head and neck oncologic revision surgery. Disease-free survival in patients undergoing revision surgery in our sample is generally poor. In our sample, there was a statistically significant difference in overall survival between the group who underwent surgery for microscopic evidence of persistent tumor (R1) versus clinical and imagiological tumoral persistency. In our sample, the time between the first and second surgeries wasn't linked with an inferior OS. Further studies with larger populations and prospective design, with longer follow-ups can be the road to a better understanding of this issue.

Impact of radiological surveillance for major blood vessels on complications of percutaneous dilatational tracheostomy: A retrospective cohort study

PurposePercutaneous dilatational tracheostomy (PDT) is the preferred method for managing long-term ventilator-dependent patients in ICUs. This study aimed to evaluate the association between preprocedural screening (ultrasound Doppler [USD] or computed tomography [CT]) for major neck blood vessels and complications in ICU patients undergoing PDT. Materials and methodsThis was a retrospective cohort study of patients who underwent PDT between 2012 and 2023 at a tertiary referral center. We performed a multivariable analysis and created a propensity-matched cohort. The primary outcome was bleeding within the first seven days after PDT. Secondary outcomes included early and late PDT complications and PTD-related mortality. ResultsA total of 1766 consecutive critically ill patients hospitalized at a tertiary academic hospital were evaluated for PDT. Of these, 881 (49.9 %) underwent only physical examination before PDT, while 885 (50.1 %) underwent additional imaging (CT/USD). A higher proportion of patients in the imaging group were referred to open surgery due to suspected major blood vessels interfering with the procedure (6.2 % vs. 3.0 %, p = 0.001). Among the 1685 patients who underwent PDT, there was no significant difference in the rate of early bleeding between the physical examination group and the imaging group (4.6 % vs. 6.3 %, p = 0.12). Similarly, the overall early complication rates (5.5 % vs. 7.6 %, p = 0.08), late complication rates (1.6 % vs. 2.2 %, p = 0.42), and PDT-related mortality rates (0.7 % vs. 0.6 %, p = 0.73) did not exhibit significant differences between the two groups. In a propensity score-matched cohort, results remained consistent. ConclusionsPhysical examination can effectively identify major neck blood vessels without increasing the risk of bleeding during and after PDT.

Fatal Necrotizing Fasciitis Mediated by Escherichia coli After Parotidectomy and Neck Dissection: A Case Report and Review of the Literature.

Necrotizing soft tissue infection (NSTI) is a rare, but life-threatening, complication of head and neck surgery. We present a 70-year-old male with a history of immunosuppression who presented with polymicrobial NSTI following parotidectomy and neck dissection for cutaneous squamous cell carcinoma. The objective of this report was to promote awareness for NSTI following parotidectomy and selective neck dissection and highlight the management measures that can optimize survival outcomes. We performed a database search that identified 1,025 citations, of which 5 articles described classified as craniocervical necrotizing fasciitis following major head and neck surgery. Consent was obtained from the patient for inclusion in the research study and Institutional Review Board approval was waived. Our literature review yielded 6 cases of craniocervical necrotizing fasciitis following major head and neck surgery. This NSTI, however-unlike the others previously reported-was predominantly mediated by Escherichia coli, a bacterium associated with elevated mortality rates. Despite immediate awake fiberoptic intubation, repeated surgical debridement, and empirical antibiotic therapy, he deteriorated rapidly and was withdrawn from life-support on postoperative day seven. Prophylactic antibiotics, airway management, prompt diagnosis, and surgical debridement are critical for limiting mortality in NSTI of the head and neck.

P001 Retrospective analysis of consent for major head and neck oncology surgery, a regional center perspective

P001 Retrospective analysis of consent for major head and neck oncology surgery, a regional center perspective

25. Do same day extubations in major head and neck cases confer any overall benefit to patient care?

25. Do same day extubations in major head and neck cases confer any overall benefit to patient care?

Development of machine learning models for the prediction of long-term feeding tube dependence after oral and oropharyngeal cancer surgery

PurposeTo predict the necessity of enteral nutrition at 28 days after surgery in patients undergoing major head and neck oncologic procedures for oral and oropharyngeal cancers. Material and methodsData from 193 patients with oral cavity and oropharyngeal squamous cell carcinoma were retrospectively collected at two tertiary referral centers to train (n = 135) and validate (n = 58) six supervised machine learning (ML) models for binary prediction employing 29 clinical variables available pre-operatively. ResultsThe accuracy of the six ML models ranged between 0.74 and 0.88, while the measured area under the curve (AUC) between 0.75 and 0.87. The ML algorithms showed high specificity (range 0.87–0.96) and moderate sensitivity (range: 0.31–0.77) in detecting patients with ≥28 days feeding tube dependence. Negative predictive value was higher (range: 0.81–0.93) compared to positive predictive value (range: 0.40–0.71). Finally, the F1 score ranged between 0.35 and 0.74. ConclusionsClassification performance of the ML algorithms showed optimistic accuracy in the prediction of enteral nutrition at 28 days after surgery. Prospective studies are mandatory to define the clinical benefit of a ML-based pre-operative prediction of a personalized nutrition protocol.

Predicting the need for prophylactic gastrostomy in major head and neck cancer surgery: The PEG score.

To elaborate a preoperative score to predict the necessity of enteral nutrition at 28 days postoperatively in patients undergoing head and neck surgery. A total of 424 patients with oral cavity, oropharyngeal, laryngeal, and hypopharyngeal carcinoma were retrospectively enrolled and analyzed to identify preoperative predictors of prolonged postsurgical enteral feeding which were used to create a prediction model with an easy-to-use nomogram. Five preoperative variables (body mass index, previous radiotherapy, preoperative dysphagia, type of surgery, flap reconstruction) were found to be independent predictive factors and were used to create a prediction model named PEG score together with the related nomogram. Accuracy, F1, and the area under the curve (AUC) were 0.74, 0.83, and 0.74. Different decision thresholds can be used to vary the sensitivity and specificity. The PEG score showed high prediction performances for modeling the need for enteral nutrition at 28 days postoperatively. Prospective studies are needed to define a personalized nutrition protocol.

Head & Neck Oncology Track: Implementation of Preoperative Normovolemic Hemodilution in Major Head and Neck Surgery

Head & Neck Oncology Track: Implementation of Preoperative Normovolemic Hemodilution in Major Head and Neck Surgery

Chronic heart failure in patients undergoing major head and neck surgery: A hospital-based study

ObjectiveTo investigate the effects of chronic heart failure on various post-operative outcomes in head and neck cancer patients undergoing major cancer surgery. Study designFor this retrospective cohort study of patients undergoing major head and neck cancer surgery, a sample of 10,002 patients between 2017 and 2019 were identified through the Nationwide Inpatient Sample. SettingPatients were selected as undergoing major head and neck cancer surgery, defined as laryngectomy, pharyngectomy, glossectomy, neck dissection, mandibulectomy, and maxillectomy, then separated based on pre-surgical diagnosis of chronic heart failure. MethodsThe effects of pre-operative chronic heart failure on post-surgical outcomes in these patients were investigated by univariable and multivariable logistic regression using ICD-10 codes and SPSS. ResultsA diagnosis of chronic heart failure was observed in 265 patients (2.6 %). Patients with chronic heart failure had more preexisting comorbidities when compared to patients without chronic heart failure (mean ± SD; 4 ± 1 vs. 2 ± 1). Multivariable logistic regression showed that chronic heart failure patients had significantly greater odds of dying during hospitalization (OR 2.86, 95 % CI 1.38–5.91) and experiencing non-routine discharge from admission (OR 1.89, 95 % CI 1.41–2.54) after undergoing major head and neck cancer surgery. ConclusionChronic heart failure is associated with greater length of stay and hospital charges among head and neck cancer patients undergoing major head and neck cancer surgeries. Chronic heart failure patients have significantly greater rates of unfavorable post-operative outcomes, including death during hospitalization and non-routine discharge from admission.

Histomorphological study of tongue in Indigenous peacock (Pavo cristatus)

The current study aimed to examine the histomorphological features of the oral salivary ducts and the peacock tongue (Pavo cristatus) of this species. In this study, eight healthy adult peacocks were used after collecting them from a commercial market in Baghdad to investigate and describe the tongue in these bird species. After being euthanized, they were killed by cutting off the major neck blood vessels and bleeding until death; the tongue was identified. The tongue was the sharp end, elongated, somewhat triangular, and measured 8.2 mm. The apex, trunk, and base are its three sections. There are 4 to 5 layers of big conical papillae on the area where the root and body converge. Without gustatory papillae, the dense keratinized epithelium stratified squamous epithelia that lined the dorsal surface and were sparse on the ventral surfaces. The body and tongue root contain cells of the epithelium. It was supported by hyaline cartilage as a short plate. Lingual salivary glands situated anterior and posterior are superficial branch tubuloalveolar glands. This research was conducted at the University of Baghdad/ College of Veterinary Medicine in the Anatomy and Histology Department. Our result concluded that modifying the bird tongue, papillae distribution, and mucosa epithelium histological features is mainly restricted to feeding types that also have similarities with other avian species. Keywords: peacock, tongue, lingual papillae, keratinized epithelium

235 Late Start Times Do Not Disproportionately Prolong Operating Times in Major Head and Neck Reconstruction

Abstract Introduction Operating start time delays are deemed as having a detrimental effect on theatre efficiency, subsequent delays, costs, and potentially outcomes. This study assessed the significance of delayed operating start times on major head and neck reconstruction cases and whether later starts led to disproportionately later finishes. Focus was placed on free osteocutaneous fibula flap reconstruction due to long operating times, difficult anaesthesia, frequently overrun and the perception of increased morning efficiency. Method Single centre identification of 26 patients using coding informatics that were diagnosed with an intra oral malignancy or osteoradionecrosis requiring reconstruction with a free osteocutaneous fibula flap. Data was manually retrieved between 2015 to 2020 from electronic patient records and statistical analysis was completed using Microsoft Excel. Results Total number of patients collated was 27, however 1 was excluded due to insufficient electronic logging of patient data. The total mean age was 64.8 (40-79), 50% were male (13) and 50% were female (13). The mean start time was 9:57, end time was 18:52 and duration was 10:50 (4:46 to 13:42). For surgery start times before 10:00 a.m. the mean start time was 9:31, end time was 20:16 and duration was 10:46 (8:30 to 22:56). For surgery start times after 10:00 a.m. the mean start time was 10:22, end time was 19:25 and duration was 10:54 (10:01 to 00:51). Conclusions Delayed operating start times have minimal significance on theatre efficiency and don’t disproportionally prolong operating times in major head and neck reconstruction cases.

1251 A Project Aimed at Improving the Completeness and Quality of Admission Clerking in the ENT Department

Abstract Aim Admissions notes are essential in communicating information regarding patients. The project aimed to improve the proportion of completed admission clerking and the quality of the recorded data for the ENT patients admitted to the ward. Method We have included emergency presentations and elective admissions for moderate and major head and neck surgery. Patients were identified from handover lists. Baseline data were collected across a period of six weeks, and 103 admission notes were included. Following the intervention, the data collection lasted another six weeks, and 93 documents were identified. Documents were compared against The Royal College of Surgeons of England Guidelines for Clinicians on Medical Records and Notes. Interventions to improve the standard of admission clerking included: a short departmental presentation, educational posters, and an introduction of the electronic clerking proforma. Results Following the intervention, the proportion of completed admission clerking has increased and the quality of recorded data has improved.The proportion of completed admission clerking increased from 95.4% to 100% for emergency presentations, and from 2.6% to 68.2%for elective admissions. Data completeness has improved across all documentation domains. For emergency presentations, the most notable improvement was recorded for the medication history (76.9% vs 93.0%) and allergy status (73.9% vs 87.3%). For elective admissions, the greatest improvement was noted for past medical history (2.6% vs 65.6%) and social history (0% vs. 56.5%). Conclusions In conclusion, the use of clerking proforma alongside educational presentation and posters increased the completeness and quality of admission clerking, for both emergency and elective presentations in the ENT department.

Implementation and Outcomes of ERAS Protocol for Major Oncologic Head and Neck Surgery.

Enhanced Recovery After Surgery (ERAS) protocols have been developed and successfully implemented for many surgical specialties, demonstrating reductions in length of stay, post-operative complications, and resource utilization. Currently, there are few documented applications of ERAS protocols in head and neck surgery. Additional description of head and neck surgery protocol design, implementation, and outcomes will help advance postoperative care. An ERAS protocol was designed for patients undergoing glossectomy and primary or salvage laryngectomy with or without free flap reconstruction. Following successful protocol implementation, patient outcomes and perioperative metrics were retrospectively reviewed and compared between patients prior to and following the ERAS protocol. Global comparison of ERAS and control group did not show statistically significant differences in measured perioperative outcomes. There were no statistically significant differences between the ERAS and control groups in age, sex, BMI, surgery type, or cancer stage. The ERAS protocol was associated with reduced variability in hospital length of stay (LOS), demonstrated through tighter interquartile ranges. For patients undergoing salvage laryngectomy, the ERAS protocol was associated with a significant reduction in 30-day readmission rates. Although not statistically significant, the median length of stay in the step-down unit (ISCU) and hospital was lower for specific patient groups. The implementation and evaluation of the ERAS protocol demonstrated improvement in select patient outcomes as well as areas for process improvement. This study demonstrates the insights that arise from review of this protocol even for an institution with perceived standardized procedures for major oncologic head and neck surgeries. 3 Laryngoscope, 134:732-740, 2024.

Resin cast in situ: A technique to demonstrate the vasculature of the Nervous system: In Goat Model

Background: As Anatomical education advances very rapidly, and at the same time, there is huge demand and scarcity of true biological models, mainly brain tissue. In this scenario, in 1977, Guther Von Hagens worked on plastics and experimented voraciously on diffusing various plastics into large specimens and ultimately succeeded and coined the term “Plastination”. This technique is very popular in Western countries as the latter greatly minimizes the health hazards due to formalin exposure while dealing with biological tissue. In continuation with the advancement of expensive plastination to cost-effective resin casting, especially studies over the complex structures like the brain and spinal cord. In This study, we emphasize the cost-effective Resin cast-in-situ method to demonstrate the vasculature of the brain and spinal cord. Materials and Methods: After obtaining the prior permission, we collected the Five (5) Goat heads from the slaughterhouse. Following the standard dissection procedure over the neck region, identified and canulated the major neck vessels. Through the vessels normal saline water, formalin, and pigmented resin were administered and preserved the goat head using routine preservation technique. After 36 to 48 hours, the routine dissection was scheduled to expose the brain and upper spinal cord segments, and finding were captured and recorded. Results and Discussion: The specimens show good penetration of dye in the artery and veins, and it’s easy to appreciate and study the vasculature of the brain and upper spinal cord segments, including the Bastons plexus of veins. Conclusion: In comparison with regular silicon casting, resin casting is very cost-effective and long-lasting, with good penetration of the resin substance up to the capillary level. Furthermore, similar studies may be conducted using in combination with whole organ plastination using silicon and resin embedding. KEYWORDS: Resin cast in situ, Brain Vasculature, Plastination, Silicon Casting.

Delayed Reconstruction after Major Head and Neck Cancer Resection: An Interdisciplinary Feasibility Study.

A single immediate reconstruction with free tissue transfer is the method of choice after major head and neck cancer (HNC) resection, but this is frequently associated with long operating hours. Considering regulatory working hour constraints, we investigated whether a two-staged reconstructive approach with temporary defect coverage by an artificial tissue substitute would be feasible. HNC patients underwent either immediate or delayed reconstruction after tumor resection. Patients with delayed reconstruction received preliminary reconstruction with an artificial tissue substitute followed by definitive microvascular reconstruction in a separate, second procedure. Of the 33 HNC patients, 13 received delayed reconstruction and 20 received immediate reconstruction. Total anesthesia time (714 vs. 1011 min; p < 0.002) and the total duration of hospital stay (34 ± 13 vs. 25 ± 6 days; p = 0.03) were longer in the delayed reconstruction group. Perioperative morbidity (p = 0.58), functional outcome (p > 0.1) and 5-year postoperative survival rank (p = 0.28) were comparable in both groups. Delayed reconstruction after HNC resection was feasible. Perioperative morbidity, functional outcome and overall survival were comparable to immediate reconstruction.

Early postoperative outcome after carotid artery endarterectomy with bifurcation advancement.

Background: The aim of this study is to review the single center experience in surgical treatment of carotid artery disease (CAD) using bifurcation advancement carotid endarterectomy (BA-CEA) and compare the in-hospital outcome with one of the largest nationwide carotid endarterectomy (CEA) databases worldwide, the German statutory quality assurance database (GD). Patients and methods: Data of BA-CEA procedures in the period of 2006-2015 were analyzed retrospectively. The primary endpoint was defined as combined stroke and death rate. Secondarily, isolated stroke, TIA, patient death, myocardial infarction, major neck hematoma and cranial nerve injuries were analyzed. Symptomatic and asymptomatic CAD patients were divided into two subgroups. The results were compared to extracted published data from the German database (GD). Results: Of 239 included BA-CEA procedures188 (78.7%) procedures were carried out in patients with symptomatic carotid artery stenosis. The overall perioperative combined stroke and death rate after BA-CEA was 2.5%.Five (2.1%) patients suffered from a stroke (one minor and four major strokes), of which two hemorrhagic strokes ended fatally. Overall, four (1.7%) patients died perioperatively. The combined stroke and death rate was higher in the symptomatic subgroup (3.2%; 0% in the asymptomatic group). No significant differences were found between the results of BA-CEA and the German database (n=142'074) for combined stroke and death rates and isolated stroke. Significant differences were found among the overall mortality rate (BA-CEA: 1.7% vs. GD: 0.6, p=0.04). The risk of postoperative cranial nerve injuries was also significantly higher after BA-CEA overall (BA-CEA: 5.0% vs. GD: 1.2%, p=<0.0001), in symptomatic CAD patients (BA-CEA: 4.8% vs. GD: 1.2%, p=<0.0001) and in asymptomatic CAD patients (BA-CEA: 5.9% vs. GD: 1.3%, p=0.01). Conclusions: CEA with bifurcation advancement provides comparable perioperative results, focusing on combined stroke and mortality, but seems to have some technical drawbacks, which may lead to more frequent local neurological complications.

Percutaneous tracheostomy in head and neck oncology surgery: How Covid-19 changed our practice

Enhanced experience in performing percutaneous tracheostomies during the COVID-19 pandemic resulted in changes to airway management protocol for patients undergoing major head and neck reconstructive surgery within our department. Most patients now receive a percutaneous tracheostomy over the previously favoured surgical tracheostomy. The aim of this study was to review our experience in performing percutaneous tracheostomies, whilst comparing complication rates with surgical tracheostomies performed in similar settings. All consecutive patients undergoing free flap reconstructive surgery for head and neck cancer between June 2020 and November 2021 were included, with 56 patients receiving a percutaneous tracheostomy. Data across a range of variables including age, BMI, comorbidities and complications was compared with 56 surgical tracheostomies performed for the same group of patients before the COVID-19 pandemic and resultant protocol changes. In the percutaneous group, a marginally lower complication rate was observed over the surgical tracheostomy group; 28.57% and 30.35% respectively. Analysis of the 16 patients who experienced complications in the percutaneous group led to development of selection criteria to identify appropriate patients to receive a percutaneous tracheostomy in future, based on factors such as BMI, bleeding risk and positioning deformities. The COVID-19 pandemic has offered a multitude of learning experiences for healthcare professionals to change our practice. In our unit, this has involved modifying the routine tracheostomy procedure used for airway management intra- and post-operatively in major head and neck reconstruction surgery.

SECHO: A deep reinforcement learning-based scheme for secure handover in mobile edge computing

The experience of users in Mobile Edge Computing (MEC) highly depends on data offloading whose major bottle neck is the design of handover scheme. Existing research advocates that offloading security and quality of service (QoS) should be both considered for an optimal handover. However, recent studies concentrate on improving QoS while neglect security. Due to the complexity of MEC scenarios, generating an optimal handover scheme improving both QoS and security remains a challenge. To solve this problem, we propose SECHO, a secure handover scheme for blockchain-based single-user mobile edge computing system. Then, we design a security policy selection algorithm of offloading tasks to guarantees security performance and controls overhead. Finally, we customize the neural network for a deep reinforcement learning algorithm to realize optimal handover, where a security policy selection method is engaged to collaboratively enhance offloading QoS while decreasing underlying risks. Simulation results show that SECHO leads a 29.6%–302% advantage in overall performance than existing approaches. It proves that our proposal is effective to achieve secure handover while not degrading offloading QoS.

Does Segmental Mandibulectomy Involving Critical Functional Sites Affect Quality of Life?

Segmental mandibulectomy (SM) is a morbid procedure, often indicated in the treatment of oral cavity pathology; however, the effect on quality of life resulting from resection of specific mandibular subsites has not previously been investigated. This study's primary aim was to evaluate differences in Health-Related Quality of Life (HRQoL) among patients who underwent segmental mandibulectomy with condylectomy (SMc+) or not (SMc-), and secondarily among patients who underwent SM with symphyseal resection (SMs+) or not (SMs-). A single-centre cross-sectional study was performed, identifying adults who had undergone SM over a 5-year period. Patients who had disease recurrence, further major head and neck surgery, or any surgery 3months prior to participating were excluded. Demographic, disease and treatment data were obtained via chart review. Participants completed the European Organisation for Treatment of Cancer 'General' and 'Head and Neck Specific' HRQoL modules. Condylectomy and midline-crossing resection were the primary and secondary predictor variables, while the primary outcome was HRQoL. Study variables were cross tabulated against predictor and outcome variables to identify potential confounders. The association between condylectomy and symphyseal resection on HRQoL was modelled using linear regression and subsequently with identified confounding factors. Forty-five enrolled participants completed questionnaires, of which 20 had undergone condylectomy and 14 symphyseal resection. Participants were majority male (68.9%) and on average 60.2±18years old, having undergone surgery 3.8±1.8years prior to participation. Prior to adjustment, Condylectomy patients reported significantly worse 'Emotional Function' (mean±standard deviation) (47.7±25.5 vs 68.4±26.6, P=.02), 'Social Function' (46.3±33.6 vs 61.4±28.9, P=.04) and 'Mouth Opening' (61.1±36.7 vs 29.8±38.3, P=.04) compared to the SMC- group. SMs+patients reported significantly worse scores in 'Social Function' (43.9±30.1 vs 48.3±32,1, P=.03), 'Dry Saliva' (65.1±35.3 vs 38.5±33.9, P<.01) and 'Social Eating' (48.5±45.6 vs 30.8±36.4, P<.01) compared to the SMs-group. Following adjustment only 'emotional function' in the SMc comparison retained significance (P=.04). SM causes anatomical distortion resulting in functional deficit. While the condyle and symphysis are theoretically functionally important, our findings suggest that morbidity associated with their resection may be the result of associated surgical and adjuvant treatment burden.