Quality of Life for Osteoradionecrosis Reconstruction in the Head and Neck: A Longitudinal Framework and Risk Factors.

IF 3.4 2区医学 Q1 SURGERY Plastic and reconstructive surgery Pub Date : 2025-04-01 Epub Date: 2024-10-01 DOI:10.1097/PRS.0000000000011790

Robin T Wu, Jennifer An-Jou Lin, Chun-Lin Su, Fu-Chan Wei

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Abstract

Background: Osteoradionecrosis (ORN) is an aggressive sequela of head and neck cancer, the treatment of which focuses on functional restoration and quality of life (QoL). In this study, the authors aimed to identify risks for poor QoL in ORN reconstruction and build a chronologic, longitudinal framework for QoL.

Methods: A prospective database of reconstructions performed by the senior author (F.C.W.) was reviewed from 2015 to 2023. QoL metrics (University of Washington QoL, version 4) were administered prospectively before surgery, 1 year postoperatively, and at each yearly follow-up.

Results: The study included 56 ORN patients with an average age of 58.2 years and mean radiation dose of 6412 Gy. Reconstruction was achieved most often with the fibula (55.4%) and anterolateral thigh flaps (37.5%). The total complication rate was 23.2% at a median period of 10.7 months postoperatively. Both health-related QoL in comparison with before the cancer diagnosis (62.5 versus 43.5; P = 0.030) and overall QoL during the past 7 days (50.5 versus 41.7; P = 0.029) were higher after ORN reconstruction than before. Physical QoL was rated higher before cancer reconstruction (79.0) than before ORN reconstruction (50.6; P < 0.001) and following reconstruction (52.5; P = 0.001). Social-emotional function was rated higher after ORN reconstruction compared with before reconstruction (68.7 versus 59.6; P = 0.010). Multivariate analysis showed that both postoperative social-emotional and physical function were affected by betel nut use ( P = 0.038; P = 0.025). Poor improvement in QoL from before to after ORN reconstruction was affected by maxilla involvement ( P = 0 .048) and fistula ( P = 0.004) and hardware issues ( P = 0.001).

Conclusions: The authors' longitudinal experience trended toward a decline in QoL at ORN diagnosis, with gradual improvement following reconstruction and eventual significant improvement in social-emotional, pain, anxiety, chewing, and global QoL following surgery. Betel nut use was a risk factor for poor postoperative QoL. Maxillary involvement and postoperative fistula and hardware issues were risks for nonimprovement in QoL.

Clinical question/level of evidence: Risk, III.

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头颈部骨坏死重建的患者生活质量报告：纵向框架和风险因素。

背景：骨坏死（ORN）是头颈部癌症的一种侵袭性后遗症，其治疗重点在于功能恢复和生活质量（QoL）。本研究旨在确定ORN重建过程中生活质量不佳的风险，并为生活质量建立一个时间纵向框架：方法：对资深作者在 2015-2023 年期间进行的重建手术的前瞻性数据库进行了审查。在术前、术后一年以及每年的随访中，对QoL指标（华盛顿大学[UWQoL]v4）进行了前瞻性管理：共纳入 56 名 ORN 患者（平均 58.2 岁，平均辐射量为 6412Gy）。通常使用腓骨（55.4%）和大腿前外侧皮瓣（37.5%）进行重建。总并发症发生率为 23.2%，中位数为术后 10.7 个月。"与癌症确诊前相比的健康相关生活质量"（62.5 vs 43.5；P=0.030）和 "过去 7 天的总体生活质量"（50.5 vs 41.7；P=0.029）在手术后均高于手术前。癌症重建前的身体生活质量（79.0）高于 ORN 重建前（50.6；p=0.029）：我们的纵向经验表明，在确诊为 ORN 时，患者的 QoL 呈下降趋势，而在重建后，QoL 逐渐得到改善，最终在手术后，患者的社交情感、疼痛、焦虑、咀嚼和整体 QoL 都得到了显著改善。槟榔是导致术后生活质量差的一个危险因素。上颌骨受累、术后瘘管和硬件问题是导致 QoL 无改善的风险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and reconstructive surgery 医学-外科

CiteScore

5.00

自引率

13.90%

发文量

1436

审稿时长

1.5 months

期刊介绍： For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis. Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.