Abstract
Background Appropriate reconstruction of the posterolateral mandible remains controversial.
Both osseous and soft tissues are vital components for an overall successful outcome
and are often combined in complex defects. Their respective effect on oromandibular
function in the reconstruction of different degrees of mandibular defects has been
less evaluated. This study aimed to compare patient-perceived oromandibular function
in osseous and soft tissue-only reconstructions following posterolateral mandibular
defects, defined as limited or extended.
Patients and Methods A 10-year retrospective review of consecutive patients undergoing mandibular reconstructions
of the posterolateral mandible were identified. Limited defects were defined as reaching
from the ipsilateral parasymphysis to anterior of the coronoid (sparing insertion
of muscles of mastication). Extended defects were defined as reaching from the ipsilateral
parasymphysis to posterior of the coronoid (sacrificing the muscle insertions). Functional
outcomes were assessed using the University of Washington Quality of Life questionnaire,
version 4.
Results A total of 163 patients were identified, of which 41 patients had the particular
posterolateral mandibular resections sought after. In 23 limited resections, there
was no difference in functional outcome between osseous and soft tissue-only reconstructions.
In 18 patients undergoing extended resections, osseous reconstructions demonstrated
significantly better outcomes (p = 0.011). There were no significant differences in patient demographics between the
groups.
Conclusion Our study highlights the interest of soft tissue-only reconstructions of the posterolateral
mandible. Limited resections seem not to benefit from complex osseous reconstruction
for adequate function. Conversely, there is a noteworthy positive impact on functional
outcomes in extended posterolateral mandibulectomies reconstructed with osseous tissue,
compared with soft tissue only. Although a larger study is needed to identify a stronger
relationship, these preliminary results could aid reconstructive decisions, particularly
when considering patient morbidity.
Keywords mandible - reconstruction - chewing
