Clinical Study Of Free Soft Tissue Flap Compared With Prosthetic Restoration For Maxillary Defect

[Objective]The Washington University Quality of Life Questionnaire was used to evaluate the postoperative quality of life in patients with maxillary defects and maxillary defects repaired with anterior anterolateral thigh flap using.The difference of quality of life among the patients with different repair methods was analyzed.At the same time,the factors influencing the quality of life of the patients with maxillary defect were obtained,and the speech and swallowing function of the patients after operation were evaluated by the methods of reconstruction and prosthesis.Further more,it provides more references for the choice of repair methods and clinical diagnosis and treatment of maxillary defects.[Methods]1.From 2013 to 2017,242 cases of maxillofacial defects caused by malignant tumor in Nanjing Stomatology Hospital,Medical School of Nanjing University were collected.34 patients with maxillary defect treated with anterolateral femoral flap and 40 patients with maxillary defect treated with prosthetic prosthesis were selected as subjects which meet the research criteria.The questionnaire of quality of life of University of Washington was completed during the follow-up period.2.Japanese Sakata Junfu drinking water experiment method was used to evaluate the swallowing function of the two groups of patients.The Chinese language speech intelligibility test table ? was used to test the speech intelligibility of the two groups of patients.The objective speech spectrum analysis was used in the speech test room.VS-9700 voice workstation(Beijing Yangshuo Electronic Technology Co.,Ltd.)recorded the pronunciations of the patient when pronouncing 3 vowels(/a/,/i/,/u/)in sequence.For the frequencies of the first,second,and third formants(Fl,F2,and F3)of each vowel,the linear prediction method of Voice 3.0 software was used.And another 10 normal people were selected as the control group.The variance of the collected data was analyzed.[Results]1.In terms of appearance,vitality,entertainment,shoulder function,taste,saliva,mood,anxiety,and total scores,there was no significant difference between the anterior thigh flap repair group and the prosthetic repair group.In the three items of pain,swallowing and language,the scores in the flap repair group were significantly higher than those in the sputum repair group;in the chewing items,the scores in the prosthetic repair group were significantly higher than those in the flap repair group.2.Younger patients scored higher in vitality(P=0.048)and chewing(P=0.044)than in older patients,while in emotional(P=0.011)entries,young patients scored lower than older patients.For patients with different types of maxillary defects,patients with type IIa defects scored higher on pain(P=0.002),swallowing(P=0.012)chewing(P=0.006),and emotion(P=0.022)than those with type IIb defects.Patients who did not receive adjuvant radiotherapy after surgery scored higher than those who received adjuvant radiotherapy in terms of vigor(P=0.006),recreation(P=0.004),language(P=0.042),taste(P=0.038),and saliva(P=0.002).For patients who did not undergo chemotherapy after surgery,they scored higher in terms of vitality(P?0.025)and shoulder function(P=0.015)than patients who received postoperative adjuvant chemotherapy.The presence of dentition in the mouth of patients after surgery can affect the chewing(P=0.009)function.3.There was no statistically significant difference in swallowing rating between the two groups after testing by the Japanese Sumida Junfu drinking water test method(P=0.421<0.05).4.The average values of speech articulation in flap group and prosthetic group were 96.34%and 93.92,respectively.The speech intelligibility of the prosthetic prosthesis group was significantly lower than that of the flap repair group.In the frequency spectrum analysis,the F2 values in the two groups were higher than those in the control group at the time of pronouncing/a/,/u/,and the frequency of the formant frequency of F2 was lower in the two groups than in the control group at the time of pronouncing/i/while F1 was higher than the control group.There were no statistically significant differences between the three vowels in the F3 groups.[Conclusion]1.The reconstruction of maxillary defect with anterolateral femoral flap is more effective than the traditional prosthetic prosthesis in maintaining the closure of the oral and nasal cavity of the patients,and it has obvious advantages in the recovery of speech function.However,there was no significant difference in the recovery of swallowing function and the quality of life after operation.2.Age,types of maxillary defects,postoperative adjuvant radiotherapy and chemotherapy,and postoperative dentition were associated with postoperative QOL in patients with maxillary defects.Sex had little effect on postoperative QOL in maxillary defect patients.