Adequacy of nutritional support in oral and maxillofacial resected and reconstructed patients with odontogenic tumours

Abstract

Introduction Malnutrition is an important risk factor for weakening of the host immune defence system and increasing complications in the surgical patient. In addition, swallowing and difficulty in mastication in patients with maxillofacial neoplasms often result in insufficient feeding and subsequent weight loss. Despite this, there is a world-wide paucity of studies in the literature reporting on pre-operative and post-operative nutritional support in patients with maxillofacial tumours. Aim of the study This study was undertaken to review and assess the adequacy NG feeding protocol in patients with odontogenic tumours in our unit Material and Methods This was a prospective observational study of patients who underwent resection of benign odontogenic tumours of the mandible and reconstruction of the resultant defect with autogenous bone at CHBAH and CMJAH over a six-month period. In this study, a bio-electrical impedance analysis machine (BIA), which measures the weight (kg), height (cm), body mass index (BMI), body fat (kg), muscle mass (kg) and total body water (%), was used pre-operatively to assess the body weight and composition. Post-resection or reconstruction of the defect, the patients were VII placed into intermaxillary fixation (IMF) intraoperatively. At the same time a thin, small bore polyurathane tube, the naso-gastric tube (NGT) was inserted and enteric feeds were initiated within the first 24hrs post-operatively. The aim was to deliver 25Kcal/Kg/Day of NGT feeds for a maximum of 7 days. All the body compositions were recalibrated immediately after the removal of the NGT after 7 days. Results 21 patients were included in this study (14 females and 7 males at 66% and 33% respectively). Ameloblastoma resection was the most common surgical procedure among the patients (61.9%). Post-surgically, all the body composition measures except body water decreased. The weight, muscle mass and BMI all decreased by the same amount which was 4.17%. A paired t-test pre-operatively and post-operatively showed that there was a statistically significant 2Kg decrease in the muscle mass of the female patients seven days post-surgery. Males lost a mean body fat of 2.01Kg which was statistically significant. VIII Conclusion All the patients lost both body fat and muscle mass during the 7 days postoperatively, despite being on high protein fiber containing naso-gastric feeds. These results suggest that the current feeding formula of 25Kcal/kg/hr may be inadequate in this study population. There was also a significant difference between males and females, suggesting that the delivery of nutrition should be modified according to gender or even more importantly, possibly rather be calculated according to the specific nutritional needs of the individual patient.