The Perfect Timing-Immediate versus Delayed Microvascular Reconstruction of the Mandible

Simple Summary This study evaluated the clinical and economic impacts of immediate versus delayed reconstruction of the mandible in patients following resection. Data from two German oral and maxillofacial surgery university departments provided insights into patient demographics, surgical details, medical histories, and flap survival rates. Our analysis of 177 reconstructions (72 immediate, 105 delayed) revealed no significant difference in flap survival based on timing or radiotherapy. However, immediate reconstruction is less cost-intensive. The findings aim to inform surgical decision-making, balancing patient health and cost-effectiveness. Crucially, only 18% of patients achieved functional masticatory rehabilitation, underscoring the need for improved post-surgical care pathways.Abstract In this retrospective study, the clinical and economic implications of microvascular reconstruction of the mandible were assessed, comparing immediate versus delayed surgical approaches. Utilizing data from two German university departments for oral and maxillofacial surgery, the study included patients who underwent mandibular reconstruction following continuity resection. The data assessed included demographic information, reconstruction details, medical history, dental rehabilitation status, and flap survival rates. In total, 177 cases (131 male and 46 females; mean age: 59 years) of bony free flap reconstruction (72 immediate and 105 delayed) were included. Most patients received adjuvant treatment (81% with radiotherapy and 51% combined radiochemotherapy), primarily for tumor resection. Flap survival was not significantly influenced by the timing of reconstruction, radiotherapy status, or the mean interval (14.5 months) between resection and reconstruction. However, immediate reconstruction had consumed significantly fewer resources. The rate of implant-supported masticatory rehabilitation was only 18% overall. This study suggests that immediate jaw reconstruction is economically advantageous without impacting flap survival rates. It emphasizes patient welfare as paramount over financial aspects in clinical decisions. Furthermore, this study highlights the need for improved pathways for masticatory rehabilitation, as evidenced by only 18% of patients with implant-supported dentures, to enhance quality of life and social integration.