Evaluation Of The Quality Of Life In Patients With Maxillary Defects After Rehabilitation

[Background]The maxillary defects after maxilletomy lead to serious functional(mastication,swallowing,speech,sucking,respiration)and aesthetic compromise.At present,multiple reconstructive classification schemes have been applied to maxillary defects,no current consensus has been published as to the more effective treatment option.Recently,the recognition of the multidimensional effect of maxilletomy on a patient’s quality of life(QOL)has led to increased interest.Up still now,there are few studies report the influencial factors on the quality of life after maxilletomy.[Objectives]The purpose of this paper is to report influencial factors affecting QOL in patients with maxilletomy.So that predict and improve the patient’s quality of life and provide more envidences for select reconstruction options.[Materials and Methods]The first stage was collected patients who underwent a maxillectomy between 2011.11 and 2015.06.The patients were treated in Nanjing Stomatology Hospital,Medical School of Nanjing University.The clinical,pathological and imaging data of the patients were collected.Recorded factors:gender,age,type of tumor,type of surgical path,Brown defect class,repair methods,maxillary teech status,nodal stage,postoperative adjuvant therapy(radiotherapy,chemotherapy).Of the 171 patients,119 responded to the UWQOL questionnaires.To analyze the factors that affect the quality of life.[Results]1.There was not a significant difference in QOL between female patients and male patients.2.Patients younger than 60 years had better scores in activity(P=0.003),swallowing(P=0.035),chewing(P=0.004)and speech(P=0.005)compared with patients who were older than 60 years.3.Patients with benign tumors had better scores in appearance(P=0.011),activity(P=0.022),swallowing(P=0.006),chewing(P=0.002),speech(P=0.003),shoulder function(P=0.046),saliva(P=0.002),overall UWQOL score(P<0.001)compared with those with malignant tumors.4.Patients with lymph node metastasis had worse scores in chewing(P=0.008),shoulder function(P=0.030),saliva(P=0.002),overall UWQOL score(P=0.002)compared with those with no lymph node metastasis.5.Patients who received postoperative radiation had significantly lower scores for pain(P=0.043),recreation(P=0.031),swallowing(P<0,001),speech(P=0.002),shoulder function(P=0.002),taste(P=0.006),saliva(P<0.001),overall UWQOL score(P<0.001)compared with those who did not receive radiation therapy.6.Patients who received chemotherapy therapy had significantly lower scores for activity(P=0.023),speech(P=0.050),shoulder function(P=0.002),saliva(P=0.025),overall UWQOL score(P=0.005)compared with those who had not received chemotherapy therapy.7.Patients with different type of surgical path had different scores for appearance(P=0.026).Patients surgical path transoral had significantly better scores compared with those who transfacial.8.There was significant differences in facial appearance(P=0.046)with different defect size.Patients with maxillectomy defect size Class Ⅲb had significantly lower scores compared with those who patients with maxillectomy defect size Class I,Class IIa,Class Ⅱb.9.Dentulous or partially edentulous patients showed a trend toward better appearance(P=0.041),swallowing(P=0.007),chewing(P=0.033)scores compared with edentulous patients.10.Patients had not rehabilitated had lower scores for swallowing(P=0.014),speech(P=0.012)compared with those who had rehabilited after maxillectomy.11.When maxillectomy defect size smaller than Class Ⅱb,Prosthetic obturator patients had better score for swallowing(P=0.016)compared with flap rehabilitation patients.When maxillectomy defect size was classified as Class Ⅱb or higher,There were no significant differences in appearance,swallowing,chewing,speech between prosthetic obturator rehabilitation patients and patients reconstructed with flaps.12.When maxillectomy defect size classified as Class Ⅱa,Prosthetic obturator rehabilitation patients had better score for swallowing(P=0.016)compared with flaps reconstructed patients.When maxillectomy defect size classified as Class Ⅰ and Class Ⅱb,There were no significant differences in appearance,swallowing,chewing,speech between prosthetic obturator rehabilitation patients and flaps reconstructed patients.[Conclusion]1.Age,type of tumor,nodal stage,postoperative adjuvant therapy(radiotherapy,chemotherapy)affect the quality of life of patients with maxillary defects.Gender had no effect on the quality of life of patients with maxillary defects.2.Type of surgical path and Brown defect class had effect in appearance.Dentulous or partially edentulous patients had better appearance,swallowing,chewing scores compared with edentulous patients.3.When the defect class<Ⅱb,the quality of life of obturator prosthesis group was higher than the flaps reconstructed group.When defect class ≥Ⅱb,there was no significant difference between prosthetic obturator rehabilitation patients and flaps reconstructed patients.