Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan.
Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan.
Auris Nasus Larynx. 2023 Apr;50(2):260-265. doi: 10.1016/j.anl.2022.05.016. Epub 2022 Jun 7.
Partial maxillectomy and postoperative radiotherapy are both risk factors associated with trismus. This retrospective study aimed to evaluate the incidence and severity of trismus in patients following partial maxillectomy with or without postoperative radiotherapy and to compare free flap reconstruction and prosthetic obturation.
A retrospective review of 40 oral cancer patients who underwent partial maxillectomy with or without postoperative radiotherapy was performed. Maximum interincisal distance recorded at least 6 months after surgery was classified according to a revised subjective-objective management-analytical (SOMA) scale and compared between the free flap reconstruction group (n = 12) and the prosthetic obturation group (n = 28).
Trismus was observed in 16/40 (40%) patients, and severe trismus was observed in 4/40 (10%) patients. Although no significant difference in trismus grade was observed between the free flap reconstruction and prosthetic obturation groups, both severe trismus and radiation-induced osteonecrosis were only seen in the prosthetic obturation group with postoperative radiotherapy.
Free flap reconstruction was preferable to prosthetic obturation to avoid severe trismus and radiation-induced osteonecrosis in patients who underwent both partial maxillectomy and postoperative radiotherapy.
部分上颌骨切除术和术后放疗都是与牙关紧闭相关的危险因素。本回顾性研究旨在评估行部分上颌骨切除术伴或不伴术后放疗的患者发生牙关紧闭的发生率和严重程度，并比较游离皮瓣重建和赝复体修复。
对 40 例接受部分上颌骨切除术伴或不伴术后放疗的口腔癌患者进行回顾性分析。术后至少 6 个月记录的最大切牙间距离根据修订后的主观-客观-管理-分析（SOMA）量表进行分类，并比较游离皮瓣重建组（n=12）和赝复体修复组（n=28）之间的差异。
40 例患者中有 16 例（40%）出现牙关紧闭，4 例（10%）出现严重牙关紧闭。游离皮瓣重建组和赝复体修复组的牙关紧闭严重程度差异无统计学意义，但仅在接受术后放疗并采用赝复体修复的患者中观察到严重牙关紧闭和放射性骨坏死。
对于同时接受部分上颌骨切除术和术后放疗的患者，游离皮瓣重建优于赝复体修复，以避免严重的牙关紧闭和放射性骨坏死。
