Health-related quality of life after free flap reconstruction of maxillary defects: a systematic review and meta-analysis

• Few studies report HRQOL after maxillary free flap reconstruction. • Patients consistently report unfavorable scores in functional HRQOL domains. • Psychosocial HRQOL domains appear relatively stable across instruments. • Future research should identify predictors and optimize functional recovery. Data addressing health-related quality of life (HRQOL) following maxillary reconstruction with free flaps remain scarce. Insight into these outcomes is essential for clinical decision-making. A systematic review of Medline, Embase, Web of Science, Cochrane, and Google Scholar was performed for publications on HRQOL after free flap reconstruction of maxillary defects following tumor resection or osteoradionecrosis. A meta -analysis was conducted using pooled estimates and random-effect models. In total, 5,818 unique articles were screened, 123 underwent full-text review, and 7 studies comprising 196 patients were included. Most studies used the UW-QoL (42.9%) or EORTC QLQ-H&N35 (42.9%); one used the FACE-Q Head and Neck Cancer Module. Meta-analyses revealed consistent pronounced impairments in functional domains. In the EORTC QLQ-H&N35, highest symptom burdens were observed for dry mouth, mouth opening, speech, and social eating, while pain and social contact were less affected. Lowest domain scores in UW-QoL were seen for chewing, appearance, and activity. FACE-Q results corroborated these findings, with lowest scores for eating, drinking, oral competence, and salivation. Psychosocial domains such as pain, social contact, and cancer worry were less affected. One study reported significantly better HRQOL outcomes with virtual surgical planning assisted reconstruction compared to conventional planning. Functional impairments were the most consistently patient-reported symptoms following maxillary free flap reconstruction. There is a need for well-designed, adequately powered studies that identify patient- and treatment-related predictors of HRQOL and compare different treatment options. Such insights could improve preoperative counseling and support shared decision-making, ultimately enabling more personalized, effective care.