Patel Kaushal, Kalathia Jaisukh, Krishnamoorthy Venkatesh
Department of Urology and Kidney Transplantation, Sri Sathya Sai Institute of Higher Medical Sciences, Anantapur, Andhra Pradesh, India.
Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India.
Urol Ann. 2020 Jul-Sep;12(3):259-265. doi: 10.4103/UA.UA_84_19. Epub 2020 Jul 17.
Buccal mucosal graft (BMG) is frequently used for the reconstruction of urethral strictures with acceptable donor-site morbidity after graft harvest. There are only a few prospectively designed studies with a small number of patients reporting oral complications, particularly the mouth opening in the long terms. We did an objective assessment of mouth opening before and after 6 months of BMG urethroplasty as well as pain scores.
Fifty-eight patients who underwent BMG urethroplasty were included in the study between May 2013 and December 2014. Preoperative mouth opening (reference point between two incisors with the highest of three readings taken as final) was measured using a Vernier caliper. Harvest site was left open to heal by secondary intentions. Postoperatively, mouth opening and pain scores using self-administered (Visual Analog Scale [VAS]) assessed on day 1 and day 3, and follow-up at 1 week, 1 month, and 6 months. Data were analyzed as mean (standard deviation [SD]), proportion, and median (inter-quartile range [IQR]) with two-tailedP < 0.05 as statistically significant.
The mean age was 39.6 years. The graft was harvested from a single cheek in 50% of patients. In remaining, it was taken from both cheeks, both cheeks with lip, and both cheeks with the tongue in 29.31%, 17.24%, and 3.5%, of patients, respectively. Preoperative mouth opening (5.13 cm [0.08]) was statistically significantly more than mouth opening on day 1 (4.34 cm [0.09]), day 3 (4.48 [0.09]), and day 7 (4.69 cm [0.09]). Mean difference became insignificant at the interval of 1 month (4.91 cm [0.09]) with 6 months' values showing marginal improvement over preoperative values (5.14 cm [0.07]). Pain was tolerable and patients reported low median VAS 2 (2-4) on day 1 and day 3 each. Reported median VAS became 0 (0-0) on day 7.
Mouth opening restriction after BMG urethroplasty is a definite entity in the initial postoperative period, which becomes nonsignificant by 6 months. The pain has no effect on mouth opening.
颊黏膜移植片（BMG）常用于尿道狭窄重建，取片后供区发病率可接受。仅有少数前瞻性设计研究，纳入患者数量少，报告了口腔并发症，尤其是长期的张口受限情况。我们对BMG尿道成形术6个月前后的张口度以及疼痛评分进行了客观评估。
2013年5月至2014年12月期间，58例行BMG尿道成形术的患者纳入本研究。术前张口度（以游标卡尺测量两切牙间距离，取三次读数中的最大值作为最终值）。取片部位开放，二期愈合。术后，于第1天、第3天以及1周、1个月和6个月随访时，采用患者自评的视觉模拟量表（VAS）评估张口度和疼痛评分。数据以均数（标准差[SD]）、比例以及中位数（四分位间距[IQR]）进行分析，双侧P<0.05为具有统计学意义。
平均年龄为39.6岁。50%的患者移植片取自单侧脸颊，其余患者中，分别有29.31%、17.24%和3.5%的患者取自双侧脸颊、双侧脸颊加唇部以及双侧脸颊加舌部。术前张口度（5.13 cm[0.08]）在统计学上显著大于术后第1天（4.34 cm[0.09]）、第3天（4.48[0.09]）和第7天（4.69 cm[0.09]）的张口度。在1个月时平均差异不显著（4.91 cm[0.09]），6个月时的值相较于术前值（5.14 cm[0.07]）有轻微改善。疼痛可耐受，患者在第1天和第3天报告的VAS中位数较低，分别为2（2 - 4）。在第7天报告的VAS中位数变为0（0 - 0）。
BMG尿道成形术后的张口受限在术后初期是明确存在的，但在6个月时变得不显著。疼痛对张口度无影响。
