Microsurgical Reconstruction of the Mandible: Patient Satisfaction and Aesthetic Outcomes.

BACKGROUND: Mandibular reconstruction after tumor resection or destructive pathology is one of the most complex challenges in craniofacial surgery. Although flap survival and functional restoration are well documented, less is known about long-term patient satisfaction and aesthetic outcomes. This study evaluated patient-reported outcomes and blinded surgeon assessments following microsurgical mandibular reconstruction. METHODS: Twenty-one patients underwent mandibular reconstruction with free bone grafts, with a mean follow-up of 11.0 years (SD=4.6; range, 2-16). Nineteen patients received iliac crest grafts and 2 underwent fibula flap reconstruction. Patient-reported outcomes were measured with a modified Orthognathic Quality of Life Questionnaire, excluding 4 dental-related items (maximum score 72). Standardized postoperative photographs were available for 13 patients and evaluated independently by 4 surgeons across 5 aesthetic domains. Descriptive statistics, linear regression, Spearman correlations, and intraclass correlation coefficients were applied. RESULTS: Mean age at follow-up was 40.5 years (SD=20.5; range, 10-90); 52.4% were female. Ameloblastoma was the most common diagnosis (52.4%). Questionnaire scores indicated favorable long-term outcomes. Surgeons consistently rated aesthetic results highly, especially for scars and proportionality. Inter-rater reliability was moderate for symmetry and overall outcome, fair for contour and proportionality, and poor for scars. Worse surgeon ratings correlated with higher Questionnaire scores, reflecting impaired patient-reported function. CONCLUSIONS: Microsurgical mandibular reconstruction provides durable aesthetic and functional benefits with high long-term patient satisfaction. Combining validated patient-reported measures and blinded surgeon evaluations offers a robust framework for outcome assessment.