الفهرس 
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Abstract
Progress in the treatment of oral cancer has made it possible to reduce the post-treatment mortality, and the survival rate has increased. However, the length of survival alone is an unsatisfactory measure of the success. The tumor treatment of head and neck cancer patients causes the QOL of the patients to deteriorate considerably after treatment, owing to the impairment of such important functions as eating, swallowing ,chewing and speech on one hand, and aesthetic aspects related to socialization on the other. This is why maxillofacial reconstruction with free flap
has such an important place as the major step in the tumor treatment procedure.
In our study, the gender difference, with a male:female patient ratio of 3:1, appeared to be significantly less marked than reported in earlier studies, which is explained by increasingly higher rates of women smoking and drinking alcohol.
50% of our patients consumed alcohol and smoked on a regular basis, which further
worsen the QOL through increase of the risk (and the related stress) of a local recurrence, and affect the patients’ family and social relations.
A majority of the patients (51.25%) had received a combination of surgery and radiation as therapy, which is in line with the oncotherapy protocol applied nowadays.
As a means of assessing changes in the QOL with the aim of a subsequent improvement, QOL questionnaires appear to provide an easily applicable, routine procedure in the care of head and neck cancer patients. We conclude that the UW QLQ questionnaires is useful tool for the evaluation of the HRQOL in patients with cancer in this region.
Statistical analysis of the results of the questionnaires suggests that post-treatment patients experienced the greatest difficulties in the areas of eating and speech.
The results of the UW QLQ demonstrated that the worst problems after treatment related to chewing, swallowing, speech and saliva domains and the best increase after reconstruction with free flap was pain with additional significant improvements in activity and recreation. There was no change in the level of family relations. This means that tumor as a disease does not affect personal contacts in the family in a negative way and it does not need improvement. There was no positive change in employment, because most of the head and neck cancer patients had already retired before the tumor treatment, because of the general staging or some other illness. There was no significant difference between the results before and after surgery as concerns the shoulder function.
The UW-QOL questionnaire was somewhat easier to complete. It indicated that the
Worst scale problems after tumor treatment were the swallowing, chewing, speech and saliva. Among the single items, the worst problems were dry mouth and sticky
saliva as side-effects of irradiation. The free flap reconstruction resulted in the greatest changes in swallowing, social eating and speech and feeling ill.
Overall, maxillofacial reconstruction with free flap leads to significant improvements in all impaired functions and to positive changes affecting the QOL. The results of my investigations allow me to state that head and neck reconstruction with free flaps can play a key role in the life of head and neck cancer patients through the resulting improvement in their QOL.