Long-Term Health-Related Quality of Life After Jaw Reconstruction With Fibula Free Flaps Using Primary Endosseous Implants and Buried Skin Grafts to Facilitate Implant-Retained Dental Prostheses.

BACKGROUND: Data on health-related quality-of-life (HRQoL) is indispensable in understanding patient outcomes following jaw reconstruction. This study aims to evaluate long-term HRQoL using validated patient-reported outcome measures (PROMs) following jaw reconstruction using buried skin grafts to facilitate implant-retained dental prosthetic rehabilitation. METHODS: A cohort study of all patients that underwent prelamination as described by Rohner or the Sydney Modified-Alberta Reconstruction Technique (SM-ART) from October 2012 to June 2023 at Chris O'Brien Lifehouse, Sydney, Australia with HRQoL data was conducted. HRQoL was assessed using the FACE-Q Head and Neck Cancer Module, MD Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI) at one-year intervals from baseline to 5 years post-operatively. RESULTS: Twenty-eight cases (Rohner technique; n = 19 or SM-ART; n = 9) were included (median age, 52 years). Six dental implant losses were recorded across five patients (median time to implant loss, 21.5 months). Three patients required denture removal; however, all had an implant-retained prosthesis at end of follow-up. While cross-sectional HRQoL scores were lower across most subscales at 12 months post-operatively as compared with baseline, mean scores among available respondents showed favourable trends towards baseline by 60 months. Appearance distress notably improved beyond baseline (mean difference [MD] +19.9, 95% confidence interval [CI] -4.1 to 43.9), while oral competence (MD -16.6, 95% CI -53.4 to 20.2) and eating distress (MD -8.5, 95% CI -50.3 to 33.3) suggested a more persistent deficit. CONCLUSIONS: Favourable trends in long-term HRQoL were observed following these reconstructive techniques to optimise dental rehabilitation, although long-term estimates should be interpreted cautiously. These data may help inform patient counselling regarding the anticipated trajectory of recovery.