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Chen JK, Kao WH, Huang PH, Tsao CK, Nee TE. Longitudinal outcomes of trismus release with free-flap reconstruction in primary and secondary oral submucous fibrosis-related trismus. J Plast Reconstr Aesthet Surg 2024; 92:26-32. [PMID: 38489984 DOI: 10.1016/j.bjps.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/08/2023] [Accepted: 02/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Oral submucous fibrosis is a global health concern associated with betel quid use and results in trismus, which can be either primary or secondary in origin. Severe cases often require trismus release with free-flap reconstruction. This study examined longitudinal outcome trends following trismus release and compared the outcomes of patients with primary and secondary oral submucous fibrosis-related trismus. METHODS We conducted a retrospective cohort study by including patients who underwent trismus release between 2013 and 2022. All procedures were performed by a single surgical team to ensure technique standardisation. We measured the maximum mouth opening, the interincisal distance, perioperatively and 1, 2, 3, 4, 6 and 12 months post-operatively. Data were analysed using generalised estimating equations. RESULTS A total of 35 patients were included in the study, 17 with primary and 18 with secondary oral submucous fibrosis-related trismus. Initially, patients with primary oral submucous fibrosis-related trismus had greater interincisal distance gains than those with secondary oral submucous fibrosis-related trismus (p = 0.015 and p = 0.025 at 3 and 4 months post-operatively, respectively). However, after 12 months, this initial advantage faded, with comparable interincisal distance improvements in patients with primary and secondary disease, despite the more complex surgical procedures required in secondary cases. CONCLUSION Surgeons should carefully consider the benefits of trismus release procedures for patients with secondary oral submucous fibrosis-related trismus by recognising the changes in post-operative outcomes.
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Affiliation(s)
- Jyh-Kwei Chen
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Chang Gung Memorial Hospital Taipei Branch, Taipei, Taiwan
| | - Wen-Hsiang Kao
- Department of Electronic Engineering, Chang Gung University, Taoyuan, Taiwan; JC Science Corporation, New Taipei, Taiwan
| | - Pin-Hsuan Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Tzer-En Nee
- Department of Electronic Engineering, Chang Gung University, Taoyuan, Taiwan.
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Murase M, Pradhan N, Sumita YI, Wakabayashi N. Use of digital technology in prosthesis fabrication for an elderly patient with a maxillectomy and severe trismus: A clinical report. J Prosthet Dent 2023:S0022-3913(23)00330-X. [PMID: 37330360 DOI: 10.1016/j.prosdent.2023.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 06/19/2023]
Abstract
This clinical report describes a novel approach based on digital technology to fabricate a maxillofacial prosthesis for a 90-year-old woman with severe trismus who had undergone maxillectomy on the right side. The approach was safe, rapid, and less burdensome on this elderly patient, and the storage and communication of intraoral and maxillofacial prosthesis data without temporal and spatial constraints was helpful. A combination of digital and analog technology provided a maxillofacial prosthesis that improved the quality of life of this elderly patient with head and neck cancer and severe trismus.
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Affiliation(s)
- Mai Murase
- Specially Appointed Assistant Professor, Department of Advanced Prosthodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Nehasha Pradhan
- Doctoral student, Department of Advanced Prosthodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuka I Sumita
- Professor, The Division of General Dentistry, The Nippon Dental University Hospital, Tokyo, Japan and Adjunct Lecturer, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
| | - Noriyuki Wakabayashi
- Professor, Department of Advanced Prosthodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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De Pablo A, Chen JK, Tsao CK. Trismus surgery and microsurgical reconstruction after oral cancer treatment. J Surg Oncol 2023; 127:929-936. [PMID: 36806041 DOI: 10.1002/jso.27217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/20/2023] [Accepted: 02/08/2023] [Indexed: 02/20/2023]
Abstract
INTRODUCTION Trismus after oral cancer is frequent, with scarce evidence of surgical release treatment in these patients. OBJECTIVES The objective of this study is to determine the results of trismus release and free flap reconstruction after oral cancer treatment, establish immediate and long-term results, and detect factors that influence outcome. MATERIALS AND METHODS A retrospective study was performed. Preoperative, intraoperative, and follow-up interincisal distances were measured. The intraoperative, long-term gain, and postoperative loss were calculated. Analysis of the long-term results with the preoperative and intraoperative variables was performed. RESULTS Surgical release immediately increased the interincisal distance by 29.25 mm. Sixty-six percent of this gain was lost due to trismus recurrence, giving a long-term interincisal gain of 9.90 mm. Worse results were observed in patients with previous high-stage tumors, maxillectomies, skin resections, and previous radiotherapy. The were no significant differences in the results depending on the type of release or reconstruction performed, with the exception of the reconstruction with the sural flap, which presented worse results. Patients with trismus of ≤10 mm could have more range for improvement after this surgery. CONCLUSIONS The results of this surgery are moderate in the long term due to high trismus recurrence in spite of aggressive treatment.
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Affiliation(s)
- Alba De Pablo
- Department of Oral and Maxillofacial Surgery, Hospital Vall d'Hebrón, Barcelona, Spain
| | - Jyh-Kwei Chen
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chung-Kan Tsao
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Taipei, Taiwan
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Mandibular Myofibroma and Severe Trismus: A Complex Case and Review of Complications. Plast Reconstr Surg Glob Open 2022; 10:e4380. [PMID: 35720205 PMCID: PMC9197361 DOI: 10.1097/gox.0000000000004380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/27/2022] [Indexed: 11/26/2022]
Abstract
A female child was investigated for insidious onset of temporomandibular joint dysfunction and trismus in the setting of a mandibular myofibroma. Myofibromas, benign mesenchymal neoplasms composed of spindle cells, are rarely found in the oral cavity, most commonly in the mandible. These lesions are historically described as indolent with a high cure rate and minimal recurrence rates following surgical resection. The patient initially presented with concerns regarding snoring, retrognathia, and jaw ankylosis, as well as a history of trouble latching as an infant but without obvious physical deformities. Imaging revealed a large expansile lytic mass of the mandible, but no temporomandibular joint involvement; surgical biopsy evidenced myofibroma, and the lesion was resected. Over the course of disease, the lesion continued to expand, and the patient’s maximal incisal opening continued to decrease despite conservative management with jaw physiotherapy; eventually she could not open her mouth despite the absence of joint involvement. Re-exploration along with formal jaw physiotherapy was achieved and optimal jaw opening was maintained. Myofibromas are rare benign desmoid tumors that can present anywhere in the body in solitary and multicentric forms, and previously did not present significant challenges to surgical and medical management. Tumors of the mandible may present with trismus and soft tissue ankylosis, which can mimic temporomandibular joint dysfunction in the absence of joint involvement. Physical therapy, rehabilitation, and soft tissue contracture release are key to management and improving outcomes in oral cancer patients, regardless of tumor pathology.
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Smeets M, Croonenborghs TM, Van Dessel J, Politis C, Jacobs R, Bila M. The Effectiveness of Surgical Methods for Trismus Release at Least 6 Months After Head and Neck Cancer Treatment: Systematic Review. FRONTIERS IN ORAL HEALTH 2022; 2:810288. [PMID: 35128526 PMCID: PMC8814314 DOI: 10.3389/froh.2021.810288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The objective of this systematic review was to identify the different surgical treatment modalities of severe trismus after head and neck squamous cell cancer treatment. METHODS An electronic literature database search was conducted in Medline, Embase, Cochrane, Web of Science, and OpenGrey to determine articles published up to September 2021. Two observers independently assessed the identified papers for eligibility according to PRISMA guidelines. The inclusion criteria were trismus after head and neck squamous cell cancer with consecutive treatment, detailed description of the surgical procedure for trismus release, description of the initial treatment, at least 6 months between initial cancer treatment and trismus release surgery, a minimal follow-up (FU) of 6 months, and availability of full text. The quality was evaluated using the Newcastle-Ottawa scale. A subanalysis of the maximal mouth opening (MMO) was performed using a mixed-effect model. RESULTS A total of 8,607 unique articles were screened for eligibility, 69 full texts were reviewed, and 3 studies, with a total of 46 cases, were selected based on the predetermined inclusion and exclusion criteria. Three treatment strategies were identified for trismus release (1) free flap reconstruction (FFR), (2) coronoidectomy (CN), and (3) myotomy (MT). There was a clear improvement for all treatment modalities. A quantitative analysis showed a beneficial effect of CN (mean 24.02 ± 15.02 mm) in comparison with FFR (mean 19.88 ± 13.97 mm) and MT (mean 18.38 ± 13.22 mm) (P < 0.01*). An increased gain in MMO after trismus release was found if no primary resection was performed (P = 0.014*). Two studies included in the analysis had an intermediate risk of bias and one had a low risk of bias. CONCLUSION Currently available reports suggest a low threshold for performing a CN compared with FFR and MT. There is a need for high-quality randomized controlled trials with carefully selected and standardized outcome measures.
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Affiliation(s)
- Maximiliaan Smeets
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tomas-Marijn Croonenborghs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jeroen Van Dessel
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Michel Bila
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Role of Prophylactic Coronoidectomy in Oral Cancer Treatment: a Retrospective Cohort Study. Indian J Surg Oncol 2020; 11:735-739. [PMID: 33299286 DOI: 10.1007/s13193-020-01225-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 09/15/2020] [Indexed: 12/30/2022] Open
Abstract
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 (p = .01) in G1 and G2, respectively. Amongst factors predisposing to trismus, patients with oral submucous fibrosis (p = .008) had reconstruction with microvascular free flap (p = .007), without post-operative radiotherapy (p = .01) and good patient compliance (p = .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 (p = .04). Prophylactic coronoidectomy done at the time of primary surgery showed significant reduction in post-surgical trismus.
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de Pablo A, Chen YT, Chen JK, Tsao CK. Trismus surgical release and free flap reconstruction after radiation therapy in oral and oropharyngeal squamous cell carcinoma. J Surg Oncol 2017; 117:142-149. [DOI: 10.1002/jso.24806] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/18/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Alba de Pablo
- Chang Gung Memorial Hospital Linkou Branch; Plastic and Reconstructive Surgery; Taiwan
| | - Yu-Ting Chen
- Chang Gung Memorial Hospital Linkou Branch; Plastic and Reconstructive Surgery; Taiwan
| | - Jyh-Kwei Chen
- Chang Gung Memorial Hospital Linkou Branch; Oral and Maxillofacial Surgery; Taiwan
| | - Chung-Kan Tsao
- Chang Gung Memorial Hospital Linkou Branch; Plastic and Reconstructive Surgery; Taiwan
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Reducing Trismus After Surgery and Radiotherapy in Oral Cancer Patients: Results of Alternative Operation Versus Traditional Operation. J Oral Maxillofac Surg 2016; 74:1072-83. [DOI: 10.1016/j.joms.2015.11.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 11/20/2015] [Accepted: 11/28/2015] [Indexed: 11/18/2022]
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Abstract
Our purpose was to evaluate the feasibility of radial forearm free (RFF) flap, platysma myocutaneous (PM) flap, and anterolateral thigh (ALT) flap in buccal reconstruction. This study consisted of 56 patients who were categorized into 3 groups. The Student t test was used to analyze the variables. Patients in group platysma flap were significantly older, the dissection of platysma flap was easier, and the defect was significantly smaller than those in group radial forearm flap and group ALT flap. The reduction in the widths of mouth opening between group PM, group RFF, and group ALT were compared. However, the reduction of mouth-opening widths in group RFF and group ALT was significantly less than that in group PM. Platysma myocutaneous flap may be more suitable in patients with small to middle-size defect and poor status, although the flap cannot achieve a reliable result; anterolateral thigh flap and radial forearm flap can preserve the interincisal distance well even for large buccal defect, but it takes more time and skills in the operation.
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