Predictive factors for functional recovery after free tissue transfer oromandibular reconstruction

BACKGROUND: Recovery of upper aerodigestive tract function after reconstruc tion of segmental oromandiblectomy defects is frequently incomplete. The pu rpose of this study was to quantitate postreconstruction function and defin e variables that predict functional outcome in this population. METHODS: A prospective study of 21 patients who underwent microvascular fre e tissue transfer reconstruction of segmental oromandibular defects was per formed. Measures of swallowing, speech, bite, and oral intake were performe d preoperatively and at 1, 3, 6, and 12 months postoperatively or until pla teau. Preoperative versus maximal postoperative measures were compared and correlated with nine potentially predictive variables. Univariate and multi variate analyses were performed to determine the most significant predictiv e factors. RESULTS: Baseline function in the study population was abnormal. Postoperat ive bite force improved, but swallowing, speech, and oral intake were worse than preoperative. Significant (univariate) predictors of outcome included diagnosis of cancer, tongue resection, pharynx resection, and flap skin pa ddle area. Only tongue resection remained significant in multivariate analy sis. CONCLUSIONS: Increasing need for oropharyngeal lining replacement, especial ly after tongue resection, is the most important predictor of functional ou tcome in reconstruction of segmental mandible defects. Am J Surg. 1998;176: 430-435. (C) 1998 by Excerpta Medica, Inc.