97 Oral functioning in maxillectomy patients 4 When choosing between obturation or surgical reconstruction, it is important to inform the patient as well as possible. Although the Rohner-procedure gives immediate chewing ability like obturators do, for patients with a malignant tumour, the obturator offers a faster recovery of chewing capacity than the ART-procedure. Since dental oral rehabilitation under the ART procedure is initiated after completion of all cancer treatments and tissue healing, it can easily take up to 6 months to start. The choice of surgical reconstruction has the advantage of avoiding the discomfort of placing and cleaning obturators. There is also less nasalance for hard palate defects reconstructed with a SDS fibula free flap, which may be due to potential retention problems of the obturators [40]. However, all this comes with a higher price. Patients should take into account longer operating times and longer hospital stays. In addition to the higher costs, operations with a longer duration have a higher chance of increased pain, increased functional limitations, poor global recovery and decreased HRQoL 6 months after surgery [41]. Finally, despite all advances in radiology, it remains difficult to distinguish between benign post-treatment changes and recurrent malignancy [42]. In addition to the fact that the oncologist with the surgical reconstruction loses direct visual inspection, the assessment of post-surgical radiological images also becomes more difficult. Strengths and limitations of this study To our knowledge this is the first study to objectively compare masticatory performance in patients with surgically reconstructed maxillae and patients with implant supported obturator prostheses. The reliability of the MAT [43, 44] in these rare compromised patient groups are the strengths of this study. Amongst the limitations are the great variance in time between the end of treatment and the data acquisition and the cross-sectional study design. The differences between the groups, especially cultural differences in this cohort international study, and the small absolute number of patients also remain limitations. However, the most important differences; age, horizontal defect size, dental status and the number of occlusal units would be expected to benefit the masticatory function of the surgically reconstructed group. Our results therefore endorse all the more caution in favouring surgical reconstruction when it comes to masticatory function. Future research The choice between surgical reconstruction or obturation of maxilla defects remains controversial and will largely be determined by personal preferences and financial possibilities.
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