Background: Patients undergoing mandibular reconstruction often experience long-term functional and aesthetic challenges, impacting their quality of life. The objective of this study was to identify factors that most powerfully impact the long-term quality of life and functional outcome of patients following mandibular reconstruction with free fibula flaps. This investigation was undertaken to enhance the treatment of this patient population. Methods: Quality of life was assessed between March 2022 and May 2023 in 47 consecutive patients undergoing mandibular reconstruction with fibula fee flaps using the University of Washington Quality of Life Questionnaire. Evaluation of functional outcome was based on mouth opening, jaw deviation, tissue atrophy, tongue mobility, lip competence, and speech intelligibility. Results: The study found that loss of chewing was the strongest impairment of quality of life (score: 63.83). The most important negative predictors for quality of life were female gender (p=0.047), radiotherapy (quality of life subcategory p-values: p=0.007 – p=0.034), anterior segment resection (quality of life subcategory p-values: p=0.038 – p=0.045), advanced defect size (quality of life subcategory p-values: p=0.008 – p=0.035) and free-hand fibula reconstruction (quality of life subcategory p-values: p=0.003 - p=0.041). Long-term outcomes revealed that reduced tissue atrophy (quality of life subcategory p-values: p<0.001 – p=0.025) and preserved tongue mobility (quality of life subcategory p-values: p=0.002 – p=0.043), were associated with better quality of life scores. Functional limitations such as reduced mouth opening (quality of life subcategory p-values: p=0.008 – p=0.049) and impaired speech intelligibility (quality of life subcategory p-values: p<0.001 – p=0.015) were significantly correlated with lower quality of life in several domains. Conclusion: Mandibular reconstruction with fibula free flaps provides favorable long-term quality of life and functional outcomes, though certain clinical factors, including radiotherapy, anterior segment resection and defect size, significantly reduce patient-reported quality of life.
Fiedler et al. (2025) studied this question.