The possibilities of delayed reconstruction in patients with tumors of the maxillofacial region

Purpose: to evaluate the effectiveness of delayed reconstruction in patients with malignant tumors of the maxillofacial region. Material and methods. We performed a retrospective analysis of the treatment results of 68 patients with malignant tumors of the maxillofacial region (oral cavity and maxilla) stages T2-4aN0-2M0 (II-IVA), who underwent reconstruction using free revascularized flaps. All patients were treated at the Head and Neck Tumors Department of the Tomsk Cancer Research Institute in the period from 2009 to 2023. The patients were divided into two groups: group 1 (34 participants) underwent a single-stage (immediately after the primary tumor resection) reconstruction; group 2 (34 participants) underwent a delayed reconstruction. The mean period from specialized treatment to delayed reconstruction was 13.3 months.
Results. Two-year survival was achieved in 100% of patients in the delayed reconstruction group. We found a statistically significant difference (p=0.005) in the two-year oncological outcome indicators between the two groups. The mandibular biomechanics, assessed by determining the degree of mouth opening, was more favorable in group 1 patients. Favorable conditions for dental implantation were created in 31 (91.2%) patients of group 1 and in 22 (64.7%) patients of group 2 (p=0.009). The analysis of CT scans in the postoperative period demonstrated a better cosmetic result (contour symmetry) in patients of the 2nd group who underwent delayed reconstruction of the maxilla using CAD/CAM technology (mean: 203.7±106.9 cm3) compared with patients of the same group who underwent reconstruction without CAD/CAM (mean: 308.7±103.9 cm3). According to the evaluation scale for functional and cosmetic rehabilitation developed at the TNRMC Cancer Research Institute, unsatisfactory level of rehabilitation in group 2 patients amounted to 20.5%, with 4.7% experiencing complete absence of rehabilitation, in contrast to group 1 patients, where the rates were 5.8 and 2.9%, respectively. The mean period from specialized treatment to delayed reconstruction was 13.3 months.
Conclusions. Delayed reconstructive treatment allows to achieve an acceptable level of rehabilitation in patients with maxillofacial region defects. However, it should be noted that the results achieved with the delayed reconstructive interventions are inferior to the results of single-stage reconstructive surgeries, and the results of delayed mandibular reconstruction are inferior to the results of delayed maxillary reconstruction.
Keywords: delayed reconstruction, reconstruction of the maxillofacial region, delayed reconstruction issues
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study