Predictors of Oral Function and Facial Aesthetics Post Maxillofacial Reconstruction with Free Fibula Flap

Background: For maxillofacial reconstruction, free flaps have largely replaced pedicled flaps. In a Saudi Arabian sample, we (1) assessed patients' postoperative oral function and facial aesthetics (OFFA), specifically pertaining to diet, speech intelligibility, oral opening, maxilla-mandibular occlusion, and facial aesthetics (all rated 0-2) following fibular free flap surgery; and (2) identified preoperative predictors of a novel 10-point OFFA rating scale combining these 5 parameters.

Methods: We conducted a retrospective review of the medical records of all patients who underwent free fibula flap surgery for nontraumatic maxillofacial reconstruction from 2010 to 2017 and were followed postoperatively for at least 6 months or until death.

Results: In 20 patients (10 female; mean age, 33.8; range, 7-56), the results were excellent, 19 of 20 patients ultimately resuming a normal diet, one a soft diet; good oral opening in 18; and normal speech, normal occlusion, and an aesthetically good result, each in 17 patients. Half the patients had a perfect (10/10) OFFA score at final assessment, whereas 2 scored 9/10, one 8/10, and two 6/10. On univariate analysis, patient age > 45, tumor of higher malignancy potential, comorbid illness, and adjuvant radiotherapy predicted a worse OFFA score, whereas a multivariate model combining comorbid illness ( = 0.002) and preoperative radiotherapy ( = 0.010) predicted a lower OFFA score, accounting for 57% of the variance (R = 0.57).

Conclusion: In Saudi Arabia, fibular free flaps yielded overall very good to excellent results in 19 of 20 patients undergoing nontraumatic maxillofacial reconstruction.