Comparative analysis of surgical and prosthetic rehabilitation in maxillectomy: A systematic review and meta-analysis on quality-of-life scores and objective speech and masticatory measurements

János König; Kata Kelemen; Szilárd Váncsa; Bence Szabó; Gábor Varga; Krisztina Mikulás; Judit Borbély; Péter Hegyi; Péter Hermann

doi:10.1016/j.prosdent.2023.11.023

Comparative analysis of surgical and prosthetic rehabilitation in maxillectomy: A systematic review and meta-analysis on quality-of-life scores and objective speech and masticatory measurements

J Prosthet Dent. 2023 Dec 26:S0022-3913(23)00775-8. doi: 10.1016/j.prosdent.2023.11.023. Online ahead of print.

Authors

János König¹, Kata Kelemen¹, Szilárd Váncsa², Bence Szabó³, Gábor Varga⁴, Krisztina Mikulás⁵, Judit Borbély⁶, Péter Hegyi⁷, Péter Hermann⁸

Affiliations

¹ Assistant Lecturer, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; and PhD student, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
² Scientific Methodological Expert, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
³ Biostatistician, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
⁴ General & Operative Vice Director, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Full Professor, Department of Oral Biology, Semmelweis University, Budapest, Hungary; and Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
⁵ Assistant Professor, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; and Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
⁶ Associate Professor, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; and Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
⁷ Strategic Director, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; and Strategic Director, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
⁸ Director and Full Professor, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; and Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary. Electronic address: hermann.peter@semmelweis.hu.

PMID: 38151428
DOI: 10.1016/j.prosdent.2023.11.023

Abstract

Statement of problem: Patients with oro-antral communication, whether from trauma, disease, or congenital anomalies, have options for surgical reconstruction or prosthetic obturation, but guiding interdisciplinary protocols are lacking.

Purpose: The purpose of this systematic review and meta-analysis was to compare surgical reconstruction and prosthetic obturation, identifying correlations with baseline characteristics to determine the most effective approach for specific patients.

Material and methods: A systematic search was conducted in 4 databases. Searching, screening, data extraction, and risk of bias assessment were performed by 2 reviewers. Eligible studies focused on patients with palatomaxillary defects from cancer-related maxilla surgeries. Traumatic or congenital defects were excluded. The study compared prosthetic restoration (either with surgical or definitive obturators) to surgical reconstruction using flaps or grafts. Patients with surgical restoration after tooth extraction were excluded. Both subjective and objective outcomes were used for comparison.

Results: Thirteen articles were included in the qualitative synthesis and 9 in the meta-analysis. Patient scores on quality-of-life questionnaires, objective speech, and masticatory ability evaluations were compared. The number of patients who underwent surgical reconstruction was 206, whereas 260 patients received prosthetic obturators. Results showed no significant differences. In the "activity" domain of the University of Washington QoL questionnaire, however, the 1.92 (0.45, 3.40) score difference was not clinically relevant. However, the heterogeneity of trials, the transient nature of subjective evaluations, the low number of participants, and major confounding biases did not allow a solid conclusion to be drawn.

Conclusions: The growing number of maxillectomy patients demands firm evidence on which rehabilitation to choose and when it should be done. The result suggests that obturator devices and surgical reconstruction have similar effects on quality of life and health outcomes. A multicentric registry in which patient strata could be analyzed separately by age, adjuvant therapies, defect sizes, and remaining dentition is advocated.

Publication types

Review