Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Institute of Statistics, National Yang Ming Chiao Tung University, Hsin-Chu, Taiwan.
J Reconstr Microsurg. 2024 Nov;40(9):707-712. doi: 10.1055/s-0044-1782659. Epub 2024 Mar 18.
Oral cavity cancers requiring excision of the oral commissure and free flap reconstruction often requires commissuroplasty to manage oral incontinence. We aimed to evaluate the implications of primary versus delayed commissuroplasty on drooling, and interincisal distance outcomes in this cohort.
A retrospective query of head and neck cancer patients operated by a single surgeon from 2017 to 2020 was performed. Patients were included if they underwent free flap reconstruction of the oral commissure, had an immediate or delayed commissuroplasty, and had 2 years of follow-up data including Thomas-Stonell and Greenberg drooling rating scales and interincisal distance measurements.
Thirty-five patients were included in the review. Twelve patients received immediate commissuroplasty and 23 patients had delayed commissuroplasty. Interincisal distance was similar at baseline, although significantly varied between immediate and delayed commissuroplasty groups at 1 month and 2 years postoperative. Drooling scores were significantly elevated in the group treated with delayed commissuroplasty, but eventually normalized after staged surgery and follow-up. Patients treated with adjunct radiation therapy had lower interincisal distance than patients who did not have radiation.
Delayed commissuroplasty increased interincisal distance and normalize drooling in patients who required full-thickness excision of the buccal mucosa and oral commissure and free tissue reconstruction. The presented data can help to educate patients on expected postoperative outcomes and likely advocates for a second-stage procedure after completion of adjunct radiotherapy to achieve optimal commissural placement and oral competence.
需要切除口腔口角并进行游离皮瓣重建的口腔癌患者常需要进行口角成形术来治疗口腔失禁。我们旨在评估原发性与延迟性口角成形术对口角成形术后流涎和切牙间距离的影响。
对 2017 年至 2020 年由一名外科医生进行手术的头颈部癌症患者进行了回顾性查询。纳入标准为接受游离皮瓣重建口腔口角、行即刻或延迟性口角成形术且具有 2 年随访数据（包括 Thomas-Stonell 和 Greenberg 流涎评分量表和切牙间距离测量）的患者。
共纳入 35 例患者进行分析。12 例患者行即刻口角成形术，23 例患者行延迟性口角成形术。基线时切牙间距离相似，但即刻和延迟性口角成形术组术后 1 个月和 2 年时差异有统计学意义。延迟性口角成形术组的流涎评分明显升高，但在分期手术和随访后最终恢复正常。接受辅助放疗的患者的切牙间距离低于未接受放疗的患者。
对于需要全层切除颊黏膜和口腔口角并进行游离组织重建的患者，延迟性口角成形术增加了切牙间距离并使流涎正常化。所提供的数据可以帮助患者了解预期的术后结果，并可能提倡在完成辅助放疗后进行二期手术，以达到最佳口角位置和口腔功能。
