de Pablo Alba, Chen Yu-Ting, Chen Jyh-Kwei, Tsao Chung-Kan
Chang Gung Memorial Hospital Linkou Branch, Plastic and Reconstructive Surgery, Taiwan.
Chang Gung Memorial Hospital Linkou Branch, Oral and Maxillofacial Surgery, Taiwan.
J Surg Oncol. 2018 Feb;117(2):142-149. doi: 10.1002/jso.24806. Epub 2017 Aug 22.
This study aims to review our experience in trismus release followed by free flap reconstruction after radiotherapy in oral and oropharyngeal cancer, describe the results obtained in long-term follow-up and identify possible predictors of outcome.
Patients' demographics, tumor characteristics and treatment where retrieved. Surgical release and reconstructive procedures were detailed. Interincisor distances (IIDs) where measured preoperatively (PO-IID), intraoperatively after release (IO-IID) and in the last follow-up (FU-IID). Potential predictors of outcome in terms of interincisor long-term gain (LT-gain) and postoperative loss (PO-loss) were analyzed.
Twenty-eight patients were included in our study. The mean LT-gain was 8.9 ± 7.0 mm, and the PO-loss was 22.14 ± 7.27 mm. Patients with a PO-IID of 10 mm or less had a significant higher LT-gain (P = 0.038). Predictors of worse outcome included having received a previous maxillectomy during tumor ablation (lower LT-gain, P = 0.035), and previous buccal mucosa resection (higher PO-loss, P = 0.044).
Trismus release and free flap reconstruction after radiotherapy in oral and oropharyngeal cancer patients seems to be associated with modest long term results and a high incidence of trismus recurrence, particularly in cases of prior buccal resections or maxillectomy. Patients should be adequately informed and carefully selected before indicating the procedure.
本研究旨在回顾我们在口腔和口咽癌放疗后进行牙关紧闭松解并游离皮瓣重建的经验，描述长期随访结果，并确定可能的预后预测因素。
收集患者的人口统计学资料、肿瘤特征和治疗情况。详细记录手术松解和重建过程。测量术前（PO-IID）、松解术后术中（IO-IID）和最后一次随访时（FU-IID）的切牙间距离。分析切牙间长期增益（LT增益）和术后损失（PO损失）方面的潜在预后预测因素。
本研究纳入28例患者。平均LT增益为8.9±7.0mm，PO损失为22.14±7.27mm。PO-IID为10mm或更小的患者LT增益显著更高（P = 0.038）。预后较差的预测因素包括在肿瘤切除期间曾接受上颌骨切除术（LT增益较低，P = 0.035）和曾进行颊黏膜切除术（PO损失较高，P = 0.044）。
口腔和口咽癌患者放疗后进行牙关紧闭松解和游离皮瓣重建似乎与适度的长期结果及较高的牙关紧闭复发率相关，特别是在既往有颊部切除术或上颌骨切除术的病例中。在实施该手术前，应充分告知患者并仔细选择患者。
