Evaluation of long-term health-related quality of life (HRQOL) is essential for optimizing functional and psychological outcomes after major head and neck surgery. Because research on this topic is scarce, this study aimed to assess long-term HRQOL in patients following segmental mandibulectomy and osseous reconstruction. A retrospective, cross-sectional study was performed, including all consecutive patients who underwent segmental mandibulectomy and subsequent osseous reconstruction between 1993 and 2024. The primary outcome was HRQOL, assessed using the FACE-Q Head and Neck Cancer Module. Descriptive statistics summarized FACE-Q domain scores. Multivariable analyses identified associations between clinical variables and HRQOL. Of all 333 reconstructed patients, 117 were still alive and eligible for inclusion of whom 74 responded (response, 63 %) with a mean follow-up of 7.6 years (SD, 6.3) after surgery. In the long term, functional domains of the FACE-Q were most affected while psychological functioning scores remained relatively more favorable. Radiotherapy was significantly associated with lower scores in the domains of salivation (β = -28.6; p = 0.008), smile (β = -20.4; p = 0.046), and swallowing (β = -27.8; p = 0.004). Anterior mandibular defects (Brown class III-IV) were associated with poorer speech outcomes (β = -18.2; p = 0.012). Higher age at surgery was associated with poorer eating and drinking scores (β = -0.5; p = 0.008), while dental rehabilitation was associated with better scores (β = 11.7; p = 0.016). At long-term follow-up after segmental mandibulectomy and osseous reconstruction, various functional domains of HRQOL were affected, while psychological functioning scores seemed to remain relatively more favorable. Targeting modifiable factors may enhance long-term HRQOL in this population.

Background: It remains unclear whether a tubed fasciocutaneous or jejunal free flap (FCFF and JFF) is preferable for reconstruction of circumferential pharyngolaryngoesophageal defects.Methods: All consecutive patients with circumferential pharyngolaryngoesophageal defects reconstructed with an FCFF or JFF between 2000 and 2022 were included. Outcomes of interest were rates of fistulas, strictures, and donor‐site complications.Results: In total, 112 patients were included (35 FCFFs and 77 JFFs). Fistula and stricture rates were significantly lower following JFF compared to FCFF reconstructions, with 12% versus 34% (p = 0.008) and 29% versus 49% (p = 0.04), respectively. Severe donor‐site complications leading to surgical intervention or ICU admittance only occurred after JFF reconstructions (18%, p = 0.007).Conclusions: The high fistula and stricture rates in FCFF reconstructions and the rate of severe abdominal complications in JFF reconstructions illustrate inherent procedure‐specific advantages and disadvantages. Relative pros and cons should be carefully weighed when tailoring treatments to the individual needs of patients.

Background: Various operative techniques exist to reconstruct partial hypopharyngeal defects following total laryngectomy. The current study aimed to investigate and compare complications and functional results following commonly used reconstructive techniques. Methods: A systematic review and meta-analysis were performed using studies that investigated outcomes after the reconstruction of a partial hypopharyngeal defect. The outcomes of interest were fistulas, strictures, flap failure, swallowing function and postoperative speech. Results: Of the 4035 studies identified, 23 were included in this review. Four common reconstructive techniques were reported, with a total of 794 patients: (1) pectoralis major myocutaneous and (2) myofascial flap, (3) anterolateral thigh free flap and (4) radial forearm free flap. Fistulas occurred significantly more often than pectoralis major myocutaneous flaps (34%, 95% CI 23–47%) compared with other flaps (p < 0.001). No significant differences in the rates of strictures or flap failure were observed. Pectoralis major myofascial flaps were non-inferior to free-flap reconstructions. Insufficient data were available to assess speech results between flap types. Conclusion: Pectoralis myocutaneous flaps should not be the preferred method of reconstruction for most patients, considering their significantly higher rate of fistulas. In contrast, pectoralis major myofascial flaps yield promising results compared to free-flap reconstructions, warranting further investigation.

Evaluation of long-term health-related quality of life (HRQOL) is essential for optimization of functional and psychological outcomes in head and neck cancer survivors. However, few studies have assessed long-term HRQOL in survivors following microvascular tongue reconstruction. A retrospective, cross-sectional study was performed, including all consecutive patients who underwent microvascular reconstruction following tongue cancer resection between 2010 and 2020. The primary outcome was HRQOL, assessed using the FACE-Q Head and Neck Cancer Module at least 3 years after surgery. Patients were grouped by the extent of the resection: partial or hemiglossectomy versus (sub)total glossectomy. Multivariable analyses were performed between clinical variables and HRQOL. Overall, 77 of 108 invited patients with a microvascular tongue reconstruction could be included with a mean follow-up of 7.9 years (SD 2.6) after surgery. Partial or hemiglossectomy was performed in 66 patients (86 %) and (sub)total glossectomy in 11 patients (14 %). In the long-term, mostly functional domains (eating, oral competence, salivation, speech and swallowing) and psychological domains of eating distress and speaking distress were affected. In multivariable analyses, postoperative radiotherapy was associated with worse speech (p = 0.002) and swallowing function (p = 0.027). (Sub)total glossectomy was significantly associated with worse speech (p = 0.011). Older age at surgery was significantly associated with poorer oral competence (p = 0.004). Females had significantly lower scores for the domain of swallowing (p = 0.044). Long-term survivors after tongue reconstruction mainly report functionally-related HRQOL deficits. These long-term results can serve to enhance symptom management and may aid in managing patient expectations regarding long-term HRQOL.

Few studies have longitudinally assessed health-related quality of life (HRQOL) in total laryngectomy (TLE) patients. This study aimed to assess the course of HRQOL following TLE, including associations with patient-specific factors. A prospective single-center cohort study from 2014 to 2023 was performed. All consecutive TLE patients with PROM data collected from an electronic healthcare monitoring system were included. Main outcomes were: Voice Handicap Index (VHI), Hospital Anxiety and Depression Scale (HADS-A, HADS-D), EORTC-QLQ-HN-35 and QLQ-C30. Mixed-models were used to analyze PROM scores over time. Among 128 TLE patients with both pre- and postoperative PROM data, all HRQOL scores significantly improved over time, except HADS-A and HADS-D scores. Preoperative HRQOL was significantly associated with all postoperative HRQOL scores. Requirement for reconstruction was associated with better HADS-A (β = -0.3, 95 % CI -0.6 to -0.1, p = 0.020) and EORTC-QLQ-C30 scores (β = 4.5, 95 % CI 0.1-8.9, p = 0.047). Strictures were associated with worse VHI-scores (β = 27.1, 95 % CI 12.2-42.1, p = 0.001) and EORTC-QLQ-HN-35 swallowing (β = 2.2, 95 % CI 1.1-3.3, p < 0.001), speech (β = 11.8, 95 % CI 1.9-21.8, p < 0.001), and social eating scores (β = 1.4, 95 % CI 0.3-2.6, p = 0.015). Fistulas were associated with a worse EORTC-QLQ-C30 summary score (β = -10.8, 95 % CI -18.3 to -3.2, p = 0.006). Adjuvant radiotherapy was associated with better HADS-A (β = -0.3, 95 % CI -0.5 to 0, p = 0.034) and HADS-D (β = -0.4, 95 % CI -0.7 to -0.1, p = 0.014) scores. Several factors are associated with postoperative HRQOL after TLE. In addition to improving reconstructive outcomes, providing additional patient guidance and patient-tailored supportive interventions may enhance HRQOL and coping processes after TLE.