The Morbidity of Buccal Mucosal Graft Harvest for Urethroplasty and the Effect of Nonclosure of the Graft Harvest Site on Postoperative Pain

Abstract

Buccal mucosal graft harvest is not a pain-free procedure. Closure of the harvest donor site appears to worsen this pain and it may be best to leave harvest sites open. The main long-term complications are perioral numbness, persistent difficulty with mouth opening and change in salivary function.

Oral mucosa grafts for urethral reconstruction

“…[20] Barbagli et al, championed dorsal placement of graft suggesting that dorsal placement gives better vascular and mechanical support, promoting take and reducing incidence of pseudo-diverticulation and enterenteneous fistula. [30] Several studies later supported this position. [20,25,39,40] Other reports have shown no differences in outcome with respect to dorsal, lateral and ventral placements of graft.…”

“…[3] The period from the late 1990s to the present times has seen more articles focusing on donor site morbidity in cases of oral mucosal grafts and its implications. The higher prevalence of donor site complications seen in recent reports [5,[28][29][30][31][32] contrasts with the findings of earlier workers [1] probably due to greater attention on the complications following urethroplasty than on the potential complications associated with harvesting oral mucosal graft. There are also studies comparing postoperative morbidities at different intraoral sites, the latest site studied being the lateral surface of the tongue.…”

“…As a matter of fact, earlier reports have indicated a low prevalence of morbidity and complications at the donor site following oral mucosa grafts for urethral reconstruction; but it was not until recently that other researchers started documenting their contrasting experiences. [1,[29][30][31][32] Amongst the complications highlighted in the literature are intraoperative hemorrhage, postoperative infection, pain, swelling, damage to the parotid duct, limitation of mouth opening, eversion of the vermillion, loss of sensation or altered sensation in the cheek or lower lip as a result of damage to the long buccal or mental nerves and scar contracture. [1,23,[29][30][31][32] Transient paresthesia of the lower lip following neuropraxia of the mental nerve has been observed as the commonest complication.…”

“…Some authors have suggested that donor sites should be left open as this approach may reduce postoperative pain with no additional morbidity. [30] Eppley et al, opined that harvesting a graft from the buccal mucosa was more challenging due to limited access from the posterior location of the donor site. [1] The donor site was described as the area extending from the anterior tonsillar pillar to the vermillionmucosal junction of the commisure, while the superior margin was a line some millimeters below the level of the parotid duct.…”

Are Bone Allografts Safe and Effective for Today’s Dental Practitioner?

“…Favorably, autografts possess osteogenic properties and no immunogenic issues [1]; however, there are disadvantages. There can be patient pain and morbidity at the harvest site [6][7][8][9][10] as well as insufficient usable graft material procured due to donor site atrophy or an underestimate of availability. The associated costs and time involved with donor site surgery and resultant complications may be significant.…”