Restoring form, rethinking function: The dual-edged impact of maxillofacial prostheses on survival and complication outcomes in head and neck cancer—A propensity matched analysis.

Abstract

e18125 Background: Maxillofacial prosthetic rehabilitation restores form and function in patients with head and neck cancer (HNC) following surgical resection. Beyond aesthetic and functional benefits, its impact on long-term survival and clinical outcomes remains understudied. This study evaluates survival and clinical outcomes, including mortality, severe sepsis, malnutrition, oral cavity diseases, respiratory diseases, and dental care utilization, in HNC patients with and without maxillofacial prostheses. Methods: This retrospective cohort study analyzed deidentified electronic health records from TriNetX research network, from 88 U.S healthcare organizations. Patients with malignant neoplasms of the lip, oral cavity, or pharynx were identified. Cohort 1 included patients without maxillofacial prosthesis (n = 103,153), and Cohort 2 included those with prosthesis (n = 703). Propensity score matching balanced cohorts on demographics, BMI, and ECOG, yielding 695 matched patients per cohort. The primary outcome was all-cause mortality. Secondary outcomes were severe sepsis, malnutrition, oral and salivary gland diseases, respiratory diseases, and dental care utilization. Analyses included risk ratios, odds ratios, Kaplan-Meier survival estimates, and event frequency analysis. Outcomes were assessed from one day after the index even t(first qualifying diagnostic or prosthetic procedure) with no specific end date. Results: After PSM, cohorts were well-balanced (standardized differences <0.10 ). Mortality risks were similar (25.1% vs 24.9%; risk ratio [RR] 0.993; P = .94), but prosthesis users had lower survival probability (43.60% vs 46.12%; hazard ratio [HR] 1.348; P = .001). Sepsis risk was higher in non-prosthesis users (5.0% vs 2.2%; RR 2.304 ; P = .005; HR, 2.900; P < .001). Malnutrition risks were similar (18.5% vs 15.7%; RR 0.849; P = .22). Oral /salivary gland diseases were more common in prosthesis users (64.5% vs 22.8%; RR 0.353; P < .001; HR, 0.379; P < .001), with higher mean events (7.775 vs 2.848; P < .001). Respiratory diseases showed similar risks (45.1% vs 39.2%; RR 0.868; P = .15), but non-prosthesis users had more mean events (6.035 vs 3.478; P = .008). Dental examinations were more frequent in prosthesis users (10.0% vs 2.6%;RR 0.263 [95% CI, 0.154-0.449]; P < .001; HR, 0.332; P < .001), with fewer events (1.386 vs 7; P = .002). Conclusions: Maxillofacial prosthetic rehabilitation in HNC patients has a multifaceted impact with lower risk of sepsis but higher oral cavity complications, higher dental care utilization, and lower overall survival. These findings highlight the need for multidisciplinary planning integrating prosthodontic, oncologic and supportive care to optimize functional and clinical outcomes.