Complex rehabilitation after delayed reconstructive plastic surgery in patients with malignant tumors of the maxillofacial region

Abstract

The objective of this study was to assess the rehabilitation level as a criterion for the effectiveness of delayed reconstructive plastic surgery in patients with malignant tumors of the maxillofacial region. This single-center retrospective and prospective study included 68 patients with malignant tumors of the oral cavity and maxilla at stages T2–4N0–3M0 (II–IVA), who were divided into two equal groups of 34 patients each. Rehabilitation assessment encompassed the analysis of functional impairments, including mastication, swallowing, and speech, as well as mandibular biomechanics and dental implant feasibility. The rehabilitation process comprised prehabilitation and three subsequent stages incorporating ERAS protocols, speech therapy, physical therapy, remote speech training, trismus correction, and dental implantation, with favorable conditions for dental implantation achieved in 91.2% of patients in Group 1 versus 64.7% in Group 2 (p=0.017), while complete restriction of mouth opening was observed in 1.5% and 2.9%, respectively (p=0.33). Speech recovery rates were statistically significantly higher in patients undergoing simultaneous reconstruction, reaching 73.6% versus 64.7% and 68.2% versus 61.8% (p < 0.05) for the respective parameters. The developed algorithms for pre‑rehabilitation and step‑by‑step restoration of functions can be recommended for widespread use in specialized oncology centers.