Condyle Preservation in Patients With Mandibular Resection Is Associated With Enhanced Quality of Life and Function.

BACKGROUND

Operative treatment of advanced mandibular tumors may require excision of a portion of the mandible including the condyle. It is not clear how condylar excision affects postoperative quality of life (QoL).

PURPOSE: The study purpose was to measure the association between operative management of the condyle and postoperative health-related QoL and temporomandibular joint (TMJ) function.

STUDY DESIGN, SETTING, AND SAMPLE: This prospective cohort study included patients with benign mandibular lesions who underwent hemi-mandibulectomy and were treated at Taleghani and Imam Hossein Hospitals in Tehran, Iran. Patients were excluded from the study if they had a history of preoperative or postoperative radiotherapy and chemotherapy, previous TMJ surgery or trauma, autoimmune diseases that affect TMJ function, bruxism or clenching, previous TMJ problems such as degenerative joint disease, failed to return for follow-up, or refused study enrollment.

PREDICTOR VARIABLE: The predictor variable was operative management of the condyle and it was grouped into 2 levels, preserved or resected.

MAIN OUTCOME VARIABLE(S): The primary outcome was the oral health-associated QoL, which was determined using the Oral Health Impact Profile-14 questionnaire. Secondary outcome variables included maximum mouth-opening values, visual analog scale pain score, joint clicking, and joint crepitus. Outcome variables were determined pretreatment, immediately postsurgery, and 6 and 12 months postsurgery.

COVARIATES: Age, sex, and defect size were the study covariates.

ANALYSES: Repeated measures analysis of variance was conducted to compare QoL questionnaire scores, maximum mouth opening, and visual analog scale pain scores (P < .05).

RESULTS

The sample was composed of 46 subjects. Mean age was 46 ± 13.1 years in both groups and 25 patients (54%) were male. Presurgery QoL scores were 79.22 ± 1.72 for the resection group and 82.38 ± 1.21 for the preservation group (P = .6). At 12 months postsurgery, QoL, maximum mouth-opening, and pain scores were 65.89 ± 3.82, 31.56 ± 2.30, and 5.44 ± 2.45 for the resection group, while the preservation group showed significantly better scores with 78.69 ± 2.10, 40.77 ± 2.20, and 1.15 ± 0.90, respectively (P < .001 for all).

CONCLUSION AND RELEVANCE: Condyle preservation in resection treatments is associated with higher QoL scores, reduced TMJ pain, and increased maximum mouth opening. Preservation of the condyle should be considered during surgery whenever possible.