Trismus surgical release and free flap reconstruction after radiation therapy in oral and oropharyngeal squamous cell carcinoma

Pablo, A. De; Chen, Yuting; Chen, Jyh‐Kwei; Tsao, Chung‐Kan

doi:10.1002/jso.24806

Cited by 11 publications

(15 citation statements)

References 38 publications

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“…Bhrany et al [20] described a mean gain in MMO of 21.8 mm in this population of 11 cases, who all underwent a CN, without MT or FFR. A mean gain at the end of FU of 8.9 ± 7.0 mm was the outcome of De Pablo et al [21] analyzing the role of a FFR with (n = 17) or without (n = 11) a CN. Lastly, Mardini et al [22] reached a gain in MMO between 1 and 20 mm using a technique combining CN, FFR and MT.…”

Section: Study Characteristics and Individual Results Of The Included Papersmentioning

confidence: 99%

“…Lastly, Mardini et al [22] reached a gain in MMO between 1 and 20 mm using a technique combining CN, FFR and MT. Two studies included in the analysis had an intermediate risk of bias [20,22] and one had a low risk of bias [21].…”

Section: Study Characteristics and Individual Results Of The Included Papersmentioning

confidence: 99%

“…All three articles used a different subdivision for the tumor localization, so a detailed analysis of the localization was assumed too heterogeneous. Although, the buccal mucosa can be considered as the most common localization based on the finding that 25 out of a total of 46 cases were described as located in the buccal mucosa [20][21][22].…”

Section: Study Characteristics and Individual Results Of The Included Papersmentioning

confidence: 99%

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The Effectiveness of Surgical Methods for Trismus Release at Least 6 Months After Head and Neck Cancer Treatment: Systematic Review

Smeets

Croonenborghs

Dessel

et al. 2022

Front. Oral. Health

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BackgroundThe objective of this systematic review was to identify the different surgical treatment modalities of severe trismus after head and neck squamous cell cancer treatment.MethodsAn 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.ResultsA 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.ConclusionCurrently 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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Section: Study Characteristics and Individual Results Of The Included Papersmentioning

confidence: 99%

Section: Study Characteristics and Individual Results Of The Included Papersmentioning

confidence: 99%

Section: Study Characteristics and Individual Results Of The Included Papersmentioning

confidence: 99%

See 1 more Smart Citation

The Effectiveness of Surgical Methods for Trismus Release at Least 6 Months After Head and Neck Cancer Treatment: Systematic Review

Smeets

Croonenborghs

Dessel

et al. 2022

Front. Oral. Health

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“…We previously published a preliminary result on trismus surgical release and free flap reconstruction after oral cancer therapy in patients who received radiotherapy 13 . With this study, we aim to describe the experience at Chang Gung Memorial Hospital in treating trismus by surgical resection and microsurgical reconstruction after comprehensive oral cancer treatment including both radiated and nonradiated patients, to see the effect that radiation has on the final treatment results, identify other possible factors that may influence outcome, and the overall result of the surgery in these patients.…”

Section: Introductionmentioning

confidence: 99%

Trismus surgery and microsurgical reconstruction after oral cancer treatment

Pablo

Chen

Tsao

2023

Journal of Surgical Oncology

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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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“…In our series the primary cause of trismus was very heterogenic and mainly involved both surgery (which was the primary treatment in all patients) and postoperative radiotherapy. Radiotherapy does play a major role in trismus development and treatment outcome, 4,5 but previous surgery does play an important part also. Inadequate reconstruction following tumor resection as well as flap failure (total or partial) will lead to deep scarring and trismus.…”

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Tsao

Pablo

Chen

2023

Journal of Surgical Oncology

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Trismus surgical release and free flap reconstruction after radiation therapy in oral and oropharyngeal squamous cell carcinoma

Cited by 11 publications

References 38 publications

The Effectiveness of Surgical Methods for Trismus Release at Least 6 Months After Head and Neck Cancer Treatment: Systematic Review

The Effectiveness of Surgical Methods for Trismus Release at Least 6 Months After Head and Neck Cancer Treatment: Systematic Review

Trismus surgery and microsurgical reconstruction after oral cancer treatment

Reply: Comment on “Trismus surgery and microsurgical reconstruction after oral cancer treatment”

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