(A593) Patient Outcomes After Osseous vs. Soft Tissue Posterior Mandibular Reconstruction: A Systematic Review and Meta-Analysis

Introduction: Many techniques enable the optimization of posterior mandibular reconstruction as it is essential for functionality and quality of life. The aim of this review was to evaluate functional and esthetic outcomes of all patients in the current literature who underwent posterior mandibular reconstruction with osseous compared to soft tissue reconstruction.

Methods: A systematic review of Ovid MEDLINE, Embase, Web of Science and Cochrane was conducted following the 2018 PRISMA guidelines. The search strategy identified articles published until November 19, 2024 that investigated patient outcomes following posterior mandibular reconstruction of any cause by way of osseous or soft tissue techniques. Two independent reviewers screened the literature and extracted data to synthesize functional outcomes, such as trismus, occlusion, diet, and esthetic outcomes. Meta-analysis was performed using the fixed effects models in R version 4.4.2. The main outcome measures were odds ratios for subgroup analysis between osseous and soft-tissue flaps, along with prevalence proportions for each group regarding outcomes.

Results: Among 9,167 articles reviewed, 94 were included, comprising 1,119 patients from 82 studies who underwent osseous reconstruction and 695 patients from 17 studies with soft-tissue reconstruction. Malignant causes accounted for 65% of cases, The prevalence proportions for osseous reconstruction were 89% for good aesthetic outcomes (95% CI, 0.79–0.99) and 76% for resuming a normal diet (95% CI, 0.57–0.94). However, trismus (95% CI, 0.00–0.02) and malocclusion (95% CI, 0.01–0.25) were not prevalent post-procedure. No significant differences were found in return to normal diet (OR 0.69; 95% CI, 0.14–3.26) or long-term trismus (OR 0.56; 95% CI, 0.20–1.54) between the two techniques.

Conclusions: To our knowledge, this is the largest study on the impact of osseous vs. soft-tissue posterior mandibular reconstruction. Despite the prevalence of osseous techniques in the literature, no statistically significant differences were found in postoperative outcomes between the two groups.