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Comparison of Functional and Quality-of-Life Outcomes in Patients With and Without Palatomaxillary Reconstruction
A Preliminary Report
Eric M. Genden, MD;
Devin Okay, DDS;
Marita T. Stepp, MD;
Rod P. Rezaee, MD;
Jacqueline S. Mojica, MS, CCC-SLP;
Daniel Buchbinder, DDS, MD;
Mark L. Urken, MD
Arch Otolaryngol Head Neck Surg. 2003;129:775-780.
Background Orodental rehabilitation of hemipalatomaxillectomy defects can be accomplished by using a prosthetic obturator or a vascularized bone-containing free flap. Whereas prosthetic obturation offers several advantages, including the opportunity for immediate dental restoration without the need for further surgery, vascularized bone grafts provide permanent closure of the oronasal communication and bone sufficient for the placement of osseointegrated implants.
Objective To compare the functional and quality-of-life (QOL) outcomes in patients rehabilitated with a prosthetic obturator with defect-matched patients who underwent reconstruction with a vascularized bone-containing free flap.
Methods Four hemipalatomaxillectomy patients rehabilitated with a tissue-borne prosthetic obturator were compared with 4 defect-matched hemipalatomaxillectomy patients who underwent reconstruction with a vascularized bone-containing free flap. All of the patients were objectively assessed for speech, mastication, and QOL. Functional status was assessed by mastication testing, voice analysis, and nasorhinometry. Swallowing-related QOL was assessed using a patient-reported, validated swallowing QOL questionnaire, and donor site morbidity was assessed using upper extremity and lower extremity questionnaires.
Results Patients who underwent reconstruction with a vascularized bone-containing free flap achieved higher mastication and speech assessment scores with less oronasal reflux than defect-matched patients rehabilitated with a prosthetic obturator. Swallowing QOL and donor site assessments demonstrated that compared with their prosthetic counterparts, reconstruction patients enjoyed a better QOL without incurring significant donor site morbidity.
Conclusions Although palatomaxillary reconstruction with vascularized bone-containing free flaps requires a second operative site, this method of orodental rehabilitation of the hemipalatomaxillectomy defect can achieve superior functional and QOL outcomes relative to defect-matched patients rehabilitated with a prosthetic obturator.
From the Departments of Otolaryngology–Head and Neck Surgery (Drs Genden, Stepp, Rezaee, and Urken and Ms Mojica) and Oral Maxillofacial Surgery and Dentistry (Drs Okay and Buchbinder), Mount Sinai School of Medicine, New York, NY. The authors have no relevant financial interest in this article.
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