Management of the Condyle in Posterior Mandibular Reconstruction: Major Clinical and Patient-Reported Outcomes.

[BACKGROUND AND OBJECTIVES] Tumor involvement of the posterior mandible often requires resection of the mandibular condyle and associated soft tissue. This study explores clinical and patient-reported outcomes (PROs) associated with condyle preservation versus resection during reconstruction.

[METHODS] This retrospective cohort study examined patients who underwent bony free flap reconstruction of posterolateral mandible defects from 2017 to 2021. Major clinical outcomes included length of stay (LOS), duration of follow-up, cancer recurrence, and all-cause mortality. PROs were assessed using the validated FACE-Q Head and Neck Cancer module survey for overall, short-term (0-1 year postoperatively), and long-term (> 1 year postoperatively) outcomes. The cohorts included (1) condyle preservation, (2) condyle resection with condyle autotransplantation, and (3) condyle resection without autotransplantation.

[RESULTS] 94 patients were included in the study. Major clinical outcomes did not significantly differ between cohorts (all p > 0.439). Compared to the condyle-resected cohort, condyle-preserved patients overall reported superior Overall Facial Appearance (p = 0.035), Eating Function (p = 0.034), Appearance/Face Distress (p = 0.020), Eating Distress (p = 0.017), and Cancer Worry (p = 0.002). Long-term assessments revealed more marked advantages for in-situ condyle preservation compared to condyle resection in Overall Facial Appearance (p = 0.022), Eating Function (p = 0.004), Smiling Function (p = 0.035), Swallowing Function (p = 0.003), Eating Distress (p = 0.006), and Cancer Worry (p = 0.011). Among condyle-resected patients, condyle autograft did not significantly improve FACE-Q scores (all p > 0.177).

[CONCLUSIONS] In-situ condyle preservation yielded superior PROs compared to condyle resection ± condyle autograft, particularly over 1 year postoperatively. Major clinical outcomes did not significantly differ.