The mandibular defects directly affect the facial features, masticatory and articulation functions of the patients11. This damage also restricts the daily life and social activities of the patients to different degrees, and indirectly affects the psychological state and social activities of the patients12. Traditional indicators for the evaluation of oral diseases do not consider the impact of diseases on the quality of life of patients. With the change of medical model, it has become a goal that surgeons pursue to ensure patients receive better quality of life (QOL) while prolonging the survival of tumor patients through medical intervention 13.
With the constant improvement of the microsurgical technique, as well as 3D printing, the upgrade of free fibular flap surgical technique offers increasingly extensive applications in the repair of the mandibular defects14. The fibular flap is a kind of compound flap, it has the advantage of being similar to the fibular flap, but also has advantages over the fibular skin flap. It can repair not only bone tissue defects, but also soft tissue defects. When looking to repair the upper and lower jaw and adjacent tissue defects it is the tissue flap of choice. However, the biggest disadvantage when using the fibular flap is that the height is only 1.3-1.5cm. Therefore, the height of the reconstructed mandible cannot meet the needs of implant repair. In addition, the mucosal scar on the surface of the single fibular is thick, which not only increases the difficulty of imprinting15, but also easily produces peri-implant inflammation (Fig. 1). Alternatively, the folded fibular flap perfectly restores the height of the alveolar ridge, avoiding the imbalance of the coronal root ratio in implant repair16. The thin crest mucosa reduces the incidence of peri-implant inflammation, which greatly improved the sample patient groups chewing function, language expression, and further increased the patient's confidence. All flaps of the selected cases in this group survived. This included the 2 patients presenting with flap crisis 12 to 24 hours after the operation due to blocked venous reflux due to poor drainage. The flap remained completely viable following efforts to improve drainage, which involved the removal of blood clots at the bottom of the mouth and microthrombus at the anastomosis17.
After fibular transplantation, more than 90% of the follow-up patients reported that the discomfort of lower limb pain, weakness, numbness and other discomfort gradually disappeared after 6 months, and the feeling and function of lower limb movement were basically normal, without affecting daily activities, which indicated that the flap resection of the donor area had almost no effect on the mobility of the patients.
The sf-36 results showed that: all functions of the patients recovered after the surgery, but the body still could not return to the preoperative level 24 months after the surgery, the patients still felt slight discomfort in the lower limbs, itching in the scar, and even some patients still could not fully accept the fact that the fibular flap was placed in the maxillofacial region. Body pain, general health and health changes decreased significantly after the surgery, which was related to the recovery of the lower limbs of the patients. With the further exercise of function and the restoration of implant teeth, the average score 24 months after the surgery was higher than that before the surgery, and the difference was statistically significant.(3) physiological function, vitality, social function, emotional role, mental health and the total score decreased significantly three months after the operation, which was significantly related to the surgical trauma and the self-discomfort of the patients, but recovered to the preoperative level 24 months after the operation.
UW-QOL results showed that: (1) with the passage of time, the oropharyngeal function of the patients after the operation was significantly improved, especially after the implant was used to repair the dentition defect, the chewing and language of the patients were substantially changed; (2) some patients received damage to the lingual nerve during the operation, postoperative tongue numbness and a decline in taste. This generally recovered three months following the operation; (3) since the submandibular gland of the affected side will be routinely removed during the operation, there will be a temporary decrease in the amount of saliva produced after the operation, but with the compensation of other glands, the patient's symptoms decreased significantly; Results from the survey indicate that the impact on swallowing as a result of this surgery is not significantly adverse.
Emotional factors are the most influential issues for cancer patients18.We found that while the patient recovered in terms of physiological function, social function and family status, the emotional status could not return to the normal level 6 months after the surgery19. The low scores of patients in mental and mental health are largely related to the psychological reality of patients' inability to accept jaw resection and their inability to adapt to changes in basic life functions such as speech and eating after surgery20. Patients are always worried about the recurrence of the tumor and the uncertainty of the future 21, so they often experience symptoms such as irritability, fatigue, insomnia, pain, diarrhea and constipation22–25. This indicates that the emotional damage caused by the tumor to patients is more serious and long-lasting26. Patients think they are sicker than others and that their health is deteriorating27. Therefore, psychological and emotional rehabilitation treatment for patients is very important28.