Long-term outcome of patients with or without osseointegrated implants after resection of mandibular ameloblastoma and reconstruction with vascularized bone graft: functional assessment and quality of life

Publication date: Available online 28 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Marco Pappalardo, Chung-Kan Tsao, Man Lung Tsang, Jie Zheng, Yang-Ming Chang, Chi-Ying Tsai
BackgroundThe optimal management after the resection of mandibular ameloblastoma has been very challenging to surgeons. The aim of this study is to evaluate the functional, aesthetic, and life quality outcomes of patients who had a segmental mandibular resection and immediate reconstruction with or without osseointegrated implants.MethodsPatients' demographics, tumour characteristics, treatment and complications were retrieved. Patients were divided into two groups: dental rehabilitated versus non-dental rehabilitated based on the placement of osseointegrated implants followed by an implanted-retained prosthesis. Functional outcomes and quality-of-life were assessed using the Performance Status Scale, the University of Washington Quality-of-Life (UW-QOL) and the 14-item Oral Health Impact Profile (OHIP-14). Aesthetic outcome was evaluated by patients using a Visual Analogue Scale.ResultsThirty-four patients were reviewed. Twenty-two patients were included in the dental rehabilitated group, and twelve were the non-dental rehabilitated group. No recurrence of the tumour was found during the average follow-up period of 7.4-years. While both groups reported similar satisfaction in appearance, dental rehabilitated patients scored significantly higher in masticatory function and 'eating in public' (p<0.01). In the UW-QOL there were significant differences (p<0.05) regarding 'chewing', 'activity' and 'anxiety'. Indeed, dental rehabilitated patients showed a definitively better outcome in the OHIP-14 'physical disability' and 'psychological discomfort' dimensions.ConclusionVascularized bone graft reconstruction followed by immediate or delayed placement of osseointegrated implants showed as an ideal and predictable treatment modality for patients with ameloblastoma. The results suggested that patients with osseointegrated implants had a significantly better masticatory function, improved quality-of-life, and less psychological consequences.