Long-term health-related quality of life following segmental mandibulectomy and osseous reconstruction

BACKGROUND: Evaluation of long-term health-related quality of life (HRQOL) is essential for optimizing functional and psychological outcomes after major head and neck surgery. Because research on this topic is scarce, this study aimed to assess long-term HRQOL in patients following segmental mandibulectomy and osseous reconstruction. METHODS: A retrospective, cross-sectional study was performed, including all consecutive patients who underwent segmental mandibulectomy and subsequent osseous reconstruction between 1993 and 2024. The primary outcome was HRQOL, assessed using the FACE-Q Head and Neck Cancer Module. Descriptive statistics summarized FACE-Q domain scores. Multivariable analyses identified associations between clinical variables and HRQOL. RESULTS: Of all 333 reconstructed patients, 117 were still alive and eligible for inclusion of whom 74 responded (response, 63 %) with a mean follow-up of 7.6 years (SD, 6.3) after surgery. In the long term, functional domains of the FACE-Q were most affected while psychological functioning scores remained relatively more favorable. Radiotherapy was significantly associated with lower scores in the domains of salivation (β = -28.6; p = 0.008), smile (β = -20.4; p = 0.046), and swallowing (β = -27.8; p = 0.004). Anterior mandibular defects (Brown class III-IV) were associated with poorer speech outcomes (β = -18.2; p = 0.012). Higher age at surgery was associated with poorer eating and drinking scores (β = -0.5; p = 0.008), while dental rehabilitation was associated with better scores (β = 11.7; p = 0.016). CONCLUSION: At long-term follow-up after segmental mandibulectomy and osseous reconstruction, various functional domains of HRQOL were affected, while psychological functioning scores seemed to remain relatively more favorable. Targeting modifiable factors may enhance long-term HRQOL in this population.