G Lakshmi Narayana, Chandrasekar Mani
Head and Neck Surgery and Oncology, Cancer Research and Relief Trust, Chennai, Tamil Nadu India.
Kumaran Hospital, No. 214, EVR Periyar Salai (PH Road), Kilpauk, Chennai, India.
Indian J Surg Oncol. 2020 Dec;11(4):735-739. doi: 10.1007/s13193-020-01225-0. Epub 2020 Sep 26.
To evaluate the effectiveness of coronoidectomy to prevent trismus in patients undergoing primary surgery for oral cancer. Patients who underwent primary surgery for oral gingivo-buccal cancers were analysed. Group 1 (G1) consists of patients who underwent coronoidectomy during the primary ablative procedure and group 2 (G2) who underwent standard ablative surgery without coronoidectomy. Post-treatment maximum interincisor opening was compared between the two groups. Sixty-four patients were included, 31 in G1 and 33 patients in G2. Overall, 81% had reduction in mouth opening at the time of evaluation. The post-treatment mean mouth opening was 28.81 ± 8.2 and 22.30 ± 10.9 ( = .01) in G1 and G2, respectively. Amongst factors predisposing to trismus, patients with oral submucous fibrosis ( = .008) had reconstruction with microvascular free flap ( = .007), without post-operative radiotherapy ( = .01) and good patient compliance ( = .003) had significant benefit with simultaneous coronoidectomy. In the sub-group analysis in patients without OSMF and PORT, the mean reduction in mouth opening was significantly better in G1 ( = .04). Prophylactic coronoidectomy done at the time of primary surgery showed significant reduction in post-surgical trismus.
评估冠突切除术对预防口腔癌一期手术患者牙关紧闭的有效性。对接受口腔牙龈颊癌一期手术的患者进行分析。第1组（G1）由在一期切除手术中接受冠突切除术的患者组成，第2组（G2）由接受无冠突切除术的标准切除手术的患者组成。比较两组治疗后的最大切牙间开口度。共纳入64例患者，G1组31例，G2组33例。总体而言，81%的患者在评估时开口度减小。G1组和G2组治疗后的平均开口度分别为28.81±8.2和22.30±10.9（P = 0.01）。在导致牙关紧闭的因素中，患有口腔黏膜下纤维化的患者（P = 0.008）、接受微血管游离皮瓣重建的患者（P = 0.007）、未接受术后放疗的患者（P = 0.01）以及患者依从性良好的患者（P = 0.003）在同时进行冠突切除术时获益显著。在无口腔黏膜下纤维化和术后放疗的患者亚组分析中，G1组的平均开口度减小情况明显更好（P = 0.04）。一期手术时进行预防性冠突切除术可显著降低术后牙关紧闭的发生率。
