{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T23:00:07Z","timestamp":1781650807373,"version":"3.54.5"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Patients undergoing mandibular reconstruction often experience long-term functional and aesthetic challenges, impacting their quality of life (QOL). The objective of this study was to identify factors that most powerfully impact the long-term QOL and functional outcome of patients following mandibular reconstruction with free fibula flaps. This investigation was undertaken to enhance the treatment of this patient population.<\/jats:p>\n                  <jats:p>QOL was assessed between March 2022 and May 2023 in 47 consecutive patients undergoing mandibular reconstruction with fibula free flaps (FFFs) using the University of Washington QOL Questionnaire. Evaluation of functional outcome was based on mouth opening, jaw deviation, tissue atrophy, tongue mobility, lip competence, and speech intelligibility.<\/jats:p>\n                  <jats:p>The study found that loss of chewing was the strongest impairment of QOL (score: 63.83). The most important negative predictors for QOL were female gender (p\u2009=\u20090.047), radiotherapy (QOL subcategory p-values: p\u2009=\u20090.007 to p\u2009=\u20090.034), anterior segment resection (QOL subcategory p-values: p\u2009=\u20090.038 to p\u2009=\u20090.045), advanced defect size (QOL subcategory p-values: p\u2009=\u20090.008 to p\u2009=\u20090.035), and free-hand fibula reconstruction (QOL subcategory p-values: p\u2009=\u20090.003 to p\u2009=\u20090.041). Long-term outcomes revealed that reduced tissue atrophy (QOL subcategory p-values: p\u2009&lt;\u20090.001 to p\u2009=\u20090.025) and preserved tongue mobility (QOL subcategory p-values: p\u2009=\u20090.002 to p\u2009=\u20090.043) were associated with better QOL scores. Functional limitations such as reduced mouth opening (QOL subcategory p-values: p\u2009=\u20090.008 to p\u2009=\u20090.049) and impaired speech intelligibility (QOL subcategory p-values: p\u2009&lt;\u20090.001 to p\u2009=\u20090.015) were significantly correlated with lower QOL in several domains.<\/jats:p>\n                  <jats:p>Mandibular reconstruction with FFFs provides a favorable long-term QOL and functional outcomes, though certain clinical factors, including radiotherapy, anterior segment resection, and defect size, significantly reduce patient-reported QOL.<\/jats:p>","DOI":"10.1055\/a-2687-0316","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T23:15:21Z","timestamp":1755818121000},"page":"482-490","source":"Crossref","is-referenced-by-count":3,"title":["Functional Rehabilitation and Quality of Life After Fibula Free Flap Reconstruction in Mandibular Defects"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6822-3089","authenticated-orcid":false,"given":"Mathias","family":"Fiedler","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Brunnhuber","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Eichberger","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Gottsauner","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes G.","family":"Schuderer","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Maurer","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Taxis","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes K.","family":"Meier","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Gerken","sequence":"additional","affiliation":[{"name":"Center of Tumor Registry, University of Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torsten E.","family":"Reichert","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Ettl","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1111\/j.1600-0501.2005.01212.x","article-title":"Clinical outcome of dental implants placed in fibula-free flaps used for the reconstruction of maxillo-mandibular defects following ablation for tumors or osteoradionecrosis","volume":"17","author":"M Chiapasco","year":"2006","journal-title":"Clin Oral Implants Res"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1002\/hed.25452","article-title":"A systematic review of validated tools assessing functional and aesthetic outcomes following fibula free flap reconstruction of the mandible","volume":"41","author":"I Petrovic","year":"2019","journal-title":"Head Neck"},{"issue":"07","key":"ref3","doi-asserted-by":"crossref","first-page":"E2204","DOI":"10.1002\/lary.29548","article-title":"Appearance-related distress and social functioning after head and neck microvascular reconstruction","volume":"131","author":"A L Zebolsky","year":"2021","journal-title":"Laryngoscope"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1097\/SCS.0b013e3182a3057d","article-title":"Free fibula flap: assessment of quality of life of patients with head and neck cancer who have had defects reconstructed","volume":"24","author":"X Zhang","year":"2013","journal-title":"J Craniofac Surg"},{"issue":"10","key":"ref5","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1016\/j.ijom.2019.02.013","article-title":"Quality of life after mandibulectomy: the impact of the resected subsite","volume":"48","author":"A Warshavsky","year":"2019","journal-title":"Int J Oral Maxillofac Implants"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1001\/archoto.2009.18","article-title":"Influences and predictors of long-term quality of life in head and neck cancer survivors","volume":"135","author":"M W El-Deiry","year":"2009","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1002\/hed.10106","article-title":"The addition of mood and anxiety domains to the University of Washington quality of life scale","volume":"24","author":"S N Rogers","year":"2002","journal-title":"Head Neck"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1001\/archoto.2010.32","article-title":"The physical function and social-emotional function subscales of the University of Washington quality of life questionnaire","volume":"136","author":"S N Rogers","year":"2010","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.jcms.2018.12.017","article-title":"Functional and aesthetic treatment outcomes after immediate jaw reconstruction using a fibula flap and dental implants","volume":"47","author":"S Attia","year":"2019","journal-title":"J Craniomaxillofac 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Microsurg"},{"issue":"02","key":"ref21","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.tripleo.2009.03.005","article-title":"Quality of life in osteoradionecrosis patients after mandible primary reconstruction with free fibula flap","volume":"108","author":"L Wang","year":"2009","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"issue":"08","key":"ref22","doi-asserted-by":"crossref","first-page":"e840","DOI":"10.1097\/SCS.0000000000008770","article-title":"Examination of suprahyoid muscle resection and other factors affecting swallowing function in patients with advanced oral cancer after surgical resection and reconstruction","volume":"33","author":"Y Nakayama","year":"2022","journal-title":"J Craniofac Surg"},{"issue":"12","key":"ref23","doi-asserted-by":"crossref","first-page":"2918","DOI":"10.1002\/cam4.1221","article-title":"Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, 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