79 QOL related to mastication in maxillectomy patients 4 There are benefits for microsurgical reconstruction of extended maxillary and midface defects. Patients requiring adjuvant radiotherapy will take advantage of reconstructive surgery, as the risk of post-radiogenic changes in the irradiated tissues will be less pronounced. Tissue atrophy, fibrosis, and the most feared risk of osteoradionecrosis can be prevented by vascularized tissue transfer into the defect site. Moreover, surgical defect repair can lead to aesthetic benefits, and implant-retained fixed dentures can be applied. However, risks, as well as costs of reconstructive surgery, should not be underestimated. For class IIb and smaller defects, very good results can be achieved by either prosthetic obturation or surgical reconstruction [21]. Our results endorse the previously mentioned advantages of implant-supported prosthetic rehabilitation, especially in (a) preventing donor site morbidity, (b) surgical risks, and (c) longer hospitalization needed for a vascularized flap transfer [48]. The overall treatment time until adequate prosthetic rehabilitation is achieved is much shorter in prosthetic obturation. In oncologic cases, the inspection of the resection defect offers advantages during the follow-up. Strengths and limitations To our knowledge, this is the first study to objectively examine masticatory performance in patients rehabilitated with implant-supported obturator prostheses in comparison to conventional prosthetic devices. Moreover, patientreported OHRQoL-results appear to support the objective results of this study. The inclusion of only edentulous maxillectomy patients has the advantage of eliminating the bias of residual dentition, which has proven to be beneficial for masticatory performance [2, 15, 35, 49, 50]. Limitations are the cross-sectional study design, the small population, the inhomogeneous anamnesis, and the wide time span between prosthetic rehabilitation and data acquisition. Although patients in Group 1 had a mean follow-up time of 4.8 years, only four out of these nine patients had a follow-up of more than five years. Quality of life 1 year after surgery has been shown to be a good indicator of long-term quality of life [51]. Implant survival rates, however, ask for a minimum of five years, and preferably ten years, of follow-up [14, 39, 52, 53]. Future research Long-term longitudinal prospective research with a larger number of participants is required, as well as objective measurements of speech and swallowing. Comparison of functional outcomes and HRQoL after prosthetic obturation, preferably implant-supported, with surgical reconstruction would give support in the individual decision making for maxillectomy patients.
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