Mandibular reconstruction refers to the restoration of the continuity of the mandible through techniques such as autologous bone grafting, thereby restoring the patient's basic appearance, reconstructing the occlusal relationship, and restoring functions such as opening the mouth, chewing, and swallowing, in order to achieve a unity of oral and maxillofacial forms and functions. Due to the fact that mastication necessitates the coordinated efforts of the masticatory muscles, mandible, dental arch, and tongue, the recovery of masticatory function not only serves as a robust indicator for the success of surgery but also enhances the patients' quality of life, facilitating an early return to normal life. Currently, for the rehabilitation of oral function in patients after mandibular reconstruction surgery, standardized tools have been established in the fields of swallowing, occlusion, and speech assessment, and targeted training has been implemented, yielding significant therapeutic outcomes. However, research related to masticatory function faces two major challenges. First, existing assessment tools primarily focus on a single dimension, such as masticatory efficiency or subjective perception, and an integrated assessment system that encompasses multiple dimensions, including bite force distribution and oral sensory perception, has not yet been established. Second, although individual studies have explored factors affecting postoperative masticatory function, a systematic consensus has not been veached, leading to a lack of precision and individualization in clinical interventions, which significantly prolongs the patients' rehabilitation period. This paper reviews the scope and limitations of existing assessment tools for masticatory function in patients after mandibular reconstruction and systematically analyzes the key factors affecting postoperative masticatory function, aiming to promote a shift in clinical practice from "structural reconstruction" to a "function-perception collaborative rehabilitation" approach, and to provide a theoretical framework for constructing evidence-based, personalized masticatory rehabilitation programs.
Keywords：mandibular reconstruction
;
masticatory function
;
rehabilitation nursing
ZHANG Yue, GU Fen, WANG Yueping, YANG Wenyu, ZHAO Xiaomei. Research progress on masticatory function assessment tools and influencing factors in patients after mandibular reconstruction. Journal of Shanghai Jiao Tong University (Medical Science)[J], 2025, 45(4): 517-522 doi:10.3969/j.issn.1674-8115.2025.04.015
口腔颌面肿瘤（oral and maxillofacial cancer）是发生在口腔颌面、咽、喉、鼻腔及鼻窦等部位肿瘤的总称，为全球第六大常见肿瘤［1］。咀嚼是指在神经系统的支配下，通过咀嚼肌的收缩，使颞下颌关节、颌骨、牙齿及牙周组织产生节律性的运动［2］。调查发现，26%~38%的口腔颌面肿瘤患者会出现咀嚼功能障碍［3］，这通常与肿瘤部位、肿瘤分期，以及手术、放射治疗等治疗方式有关［4-5］。咀嚼功能障碍则可引发认知障碍及营养不良等并发症，增加患者的死亡风险［6］。因此，临床上多用下颌骨重建技术解决上述问题，除了维持患者颌骨基本外形，还能在此基础上再进行义齿修复及咬合功能重建，从而实现咀嚼功能的恢复［7］。有研究［8］表明，Ⅲ型口腔障碍（指有牙齿缺失和上下颌骨缺损导致的咀嚼困难）多出现在下颌骨重建术后，患者和医师都容易识别，因而主客观评估结果趋于一致；表明现有的主客观评估工具本身具有较好的效度，能够反映术后患者咀嚼功能的真实情况。但是近年来的临床实践显示，这些工具在评估此类患者咀嚼功能时仍存在明显不足，尤其是在评估工具的选择标准、规范化应用及结果解读方面缺乏共识，因而难以为患者的咀嚼康复提供充分的现实依据。因此，本研究以评估工具和影响因素为切入点，对国内外关于下颌骨重建术后患者咀嚼功能的评估和影响因素进行综述，总结目前存在的不足并提出展望，为下颌骨重建术后患者咀嚼功能的评估提供参考。
该问卷由EDMONTON教授在2016年研发，是以头颈肿瘤患者功能结局为指标的调查问卷［12］，共有33项，包括吞咽（11项）、言语（10项）、口腔干燥（7项）、咀嚼（5项）4个维度。问卷采用Likert 5级评分法，自“非常不同意”到“非常同意”依次计为1~5分，最后对每个维度进行线性变换得到总分（0~100分）；分数越高，表示功能越好。咀嚼维度包括“我能够正常咀嚼”“由于咀嚼问题，我吃东西花费时间更长”“牙齿或假牙使我难以咀嚼坚硬的食物”“吃东西时难以张大嘴巴”“难以用舌头移动口内的食物”5个条目，且该维度得分与欧洲癌症研究组织头颈癌生存质量问卷（European Organization for Research and Treatment of Cancer Quality of Life Head and Neck Cancer Module，EORTC QLQ-H&N35）中社交进食困难症状得分呈中等相关性（Pearson系数r=-0.43；95%CI -0.82~-0.04）。该问卷以患者为中心，能够真实反映咀嚼功能情况，但是目前该问卷还未应用于除美国以外的其他国家，信度和效度还有待进一步检验。
ZHANG Yue retrieved the literature and wrote the manuscript. WANG Yueping, ZHAO Xiaomei, and YANG Wenyu participated in drafting and revising the manuscript. GU Fen reviewed the article. All authors have read the final version of the paper and consented to submission.
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所有作者声明不存在利益冲突。
COMPETING INTERESTS
All authors declare no relevant conflict of interests.
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... 该问卷由EDMONTON教授在2016年研发，是以头颈肿瘤患者功能结局为指标的调查问卷［12］，共有33项，包括吞咽（11项）、言语（10项）、口腔干燥（7项）、咀嚼（5项）4个维度.问卷采用Likert 5级评分法，自“非常不同意”到“非常同意”依次计为1~5分，最后对每个维度进行线性变换得到总分（0~100分）；分数越高，表示功能越好.咀嚼维度包括“我能够正常咀嚼”“由于咀嚼问题，我吃东西花费时间更长”“牙齿或假牙使我难以咀嚼坚硬的食物”“吃东西时难以张大嘴巴”“难以用舌头移动口内的食物”5个条目，且该维度得分与欧洲癌症研究组织头颈癌生存质量问卷（European Organization for Research and Treatment of Cancer Quality of Life Head and Neck Cancer Module，EORTC QLQ-H&N35）中社交进食困难症状得分呈中等相关性（Pearson系数r=-0.43；95%CI -0.82~-0.04）.该问卷以患者为中心，能够真实反映咀嚼功能情况，但是目前该问卷还未应用于除美国以外的其他国家，信度和效度还有待进一步检验. ...
)的对比研究[J]. 华西口腔医学杂志, 2023, 41(3): 254-259.