Department of Head and Neck Oncology, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
Oral Oncol. 2018 Jul;82:152-161. doi: 10.1016/j.oraloncology.2018.05.019. Epub 2018 May 30.
Maxillary defects can be resolved by prosthetic obturation, autologous tissue reconstruction, or a combination of both. However, there is still controversy in the selection of the optimal approach. Therefore, the aim of this study was to systematically review evidences comparing the performance of obturators and flaps in patients after maxillary oncological ablation. Both electronic and manual searching approaches were conducted to identify eligible evidence. Two reviewers independently assessed the risk of bias. In addition, the same reviewers independently extracted the data. Meta-analyses were performed using Revman 5.3, and best evidence synthesis was performed. Sixteen studies were included and a total of 528 participants were analyzed. All studies were assessed at low quality. Results of this meta-analysis showed weak evidence in the difference between obturators and flaps on the outcome regarding word intelligibility (P = 0.004) and masticatory efficiency (P = 0.002). However, no differences were detected regarding speech intelligibility and nasalance. All studies were compiled into the best evidence synthesis. The sum of 31 evidences was considered. Twelve evidences were evaluated at a moderate level, such as speech, mastication, pain, salivation, taste sensations, and mouth opening. Except the outcomes of word intelligibility, masticatory efficiency, and mouth pain, other moderate evidences showed no difference between obturators and flaps. In conclusion, both obturators and flaps might be effective in patients' rehabilitation functions after maxillary ablation. However, some advantages were observed when using surgical reconstruction over prosthetic rehabilitation. Additional high-quality studies are needed to provide more solid evidence before applying these results into clinical practice.
上颌骨缺损可以通过修复体堵塞、自体组织重建或两者结合来解决。然而，在选择最佳方法方面仍存在争议。因此，本研究旨在系统地回顾比较上颌骨肿瘤切除术后使用堵塞物和皮瓣的疗效的证据。采用电子和手动搜索方法来确定合格的证据。两名评审员独立评估偏倚风险。此外，两名评审员还独立提取数据。使用 Revman 5.3 进行荟萃分析，并进行最佳证据综合。共纳入 16 项研究，共分析了 528 名参与者。所有研究的质量均较低。荟萃分析的结果显示，在语音清晰度（P = 0.004）和咀嚼效率（P = 0.002）方面，堵塞物和皮瓣之间的结果差异存在微弱证据。然而，在语音清晰度和鼻音方面没有差异。所有研究均被编译到最佳证据综合中。共考虑了 31 项证据。12 项证据的评估水平为中等，如言语、咀嚼、疼痛、流涎、味觉和张口度。除了语音清晰度、咀嚼效率和口腔疼痛的结果外，其他中等证据表明堵塞物和皮瓣之间没有差异。总之，在上颌骨切除术后，堵塞物和皮瓣都可能对患者的康复功能有效。然而，与修复治疗相比，手术重建具有一些优势。需要更多高质量的研究来提供更确凿的证据，然后才能将这些结果应用于临床实践。
