Quality of Life for Osteoradionecrosis Reconstruction in the Head and Neck: A Longitudinal Framework and Risk Factors

Background: Osteoradionecrosis (ORN) is an aggressive sequela of head and neck cancer, the treatment of which focuses on functional restoration and quality of life (QoL). In this study, the authors aimed to identify risks for poor QoL in ORN reconstruction and build a chronologic, longitudinal framework for QoL. Methods: A prospective database of reconstructions performed by the senior author (F.C.W.) was reviewed from 2015 to 2023. QoL metrics (University of Washington QoL, version 4) were administered prospectively before surgery, 1 year postoperatively, and at each yearly follow-up. Results: The study included 56 ORN patients with an average age of 58.2 years and mean radiation dose of 6412 Gy. Reconstruction was achieved most often with the fibula (55.4%) and anterolateral thigh flaps (37.5%). The total complication rate was 23.2% at a median period of 10.7 months postoperatively. Both health-related QoL in comparison with before the cancer diagnosis (62.5 versus 43.5; P = 0.030) and overall QoL during the past 7 days (50.5 versus 41.7; P = 0.029) were higher after ORN reconstruction than before. Physical QoL was rated higher before cancer reconstruction (79.0) than before ORN reconstruction (50.6; P < 0.001) and following reconstruction (52.5; P = 0.001). Social-emotional function was rated higher after ORN reconstruction compared with before reconstruction (68.7 versus 59.6; P = 0.010). Multivariate analysis showed that both postoperative social-emotional and physical function were affected by betel nut use (P = 0.038; P = 0.025). Poor improvement in QoL from before to after ORN reconstruction was affected by maxilla involvement (P = 0 .048) and fistula (P = 0.004) and hardware issues (P = 0.001). Conclusions: The authors’ longitudinal experience trended toward a decline in QoL at ORN diagnosis, with gradual improvement following reconstruction and eventual significant improvement in social-emotional, pain, anxiety, chewing, and global QoL following surgery. Betel nut use was a risk factor for poor postoperative QoL. Maxillary involvement and postoperative fistula and hardware issues were risks for nonimprovement in QoL.