Trismus surgery and microsurgical reconstruction after oral cancer treatment

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.

Delayed Commissuroplasty Increases Interincisal Distance in Buccogingival Cancer Patients Treated with Free Flap Reconstruction of the Oral Commissure

“…Tissue contracture and sclerosis can make revision of the commissure challenging, and poor healing at the site of radiated tissue may risk the need for further flaps to provide a source of healthy tissue for pliable reconstruction. De Pablo et al's 16 2023 study evaluated the role free tissue transfer plays in managing head and neck cancer-related trismus and limited IID. The group reported an immediate postoperative IID increase of nearly 30 mm and long-term gain of 9 mm after manifestation of postsurgical scarring.…”