Reconstruction of lateral mandibular defect: a comparison of functional and aesthetic outcomes of bony reconstruction vs soft tissue reconstruction - long-term follow-up

Conclusion: Reconstruction with a vascularized bone flap provided superior postoperative outcomes compared with reconstruction with a soft tissue free flap. However, patients obtained acceptable long-term functional outcomes even with a soft tissue free flap and this method is an option in selected patients. A multidisciplinary approach involving dental treatments and nutrition education is important to improve postoperative function. Objective: To assess the postoperative outcomes of two different options for reconstruction of the lateral mandible using bony or soft tissue reconstruction. Methods: We divided 25 patients into 2 groups on the basis of the type of reconstruction following lateral mandibulectomy. Twelve patients underwent reconstruction using a vascularized fibular flap and 13 patients received a soft tissue free flap. We compared the postoperative functional and aesthetic outcomes and examined the time-dependent change in functional outcomes in both groups. Results: Reconstruction with a vascularized bone flap was significantly superior to reconstruction with a soft tissue free flap in deglutition and aesthetic results. There was no significant difference in speech function between the groups. Deglutition in both groups improved markedly over time and all but one patient tolerated a normal or soft diet, including those in the soft tissue reconstruction group. Denture fabrication and recreating occlusion explained the improved deglutition.