Free flap reconstruction after surgical release of oral submucous fibrosis: long-term maintenance and its clinical implications.

Abstract

BACKGROUND AND AIM:

Oral submucous fibrosis (OSF) is an insidious disease with progressive limitation of mouth opening and potential malignant change of the oral mucosa. Cancer surveillance is of utmost importance, but it is often limited by severe trismus. Surgical release and free flap reconstruction is effective but its long-term efficacy has not been completely established. This work aims to review our experience in the past 15 years in surgical release of OSF-related trismus followed by free flap reconstruction.

METHODS:

Patient's age, gender, smoking history, drinking history and betel-nut consumption history were retrieved. Surgical release and reconstructive procedures were detailed. Inter-incisor distances (IIDs) were measured preoperatively (PO-IID), intra-operatively after maximal release (IO-IID) and during the last follow-up (FU-IID). Subsequent development of oral cancers (oral squamous cell carcinoma, OSCC) and relevant details were documented. Potential predictors of long-term IID gain were analysed.

RESULTS:

A total of 92 patients were included in our study. There was a significant difference (p = 0.000) in PO-IID (13.8 ± 6.6 mm) and FU-IID (27.2 ± 8.8 mm) indicating the long-term efficacy of the release procedure. The mean long-term IID gain was 13.0 ± 7.5 mm. Bilateral coronoidectomy resulted in a greater degree of intra-operative gain in IID (p = 0.025). PO-IID (r = -0.277, p = 0.001) and intra-operative gain in IID (r = 0.198, p = 0.001) were found to be predictive of long-term IID gain. Ten patients (11%) developed OSCC during our study period.

CONCLUSIONS:

Aggressive surgical release (with bilateral coronoidectomy if necessary) followed by free flap reconstruction is an effective treatment for OSF-related trismus. Our study has confirmed its long-term efficacy and its important role in cancer surveillance.

• Authors: Richie Chiu-Lung Chan, Fu-Chan Wei, Chung-Kan Tsao, Huang-Kai Kao, Yang-Ming Chang, Chi-Ying Tsai, Wen-Ho Chen
• Journal: Journal of plastic, reconstructive & aesthetic surgery : JPRAS (J Plast Reconstr Aesthet Surg) Vol. 67 Issue 3 Pg. 344-9 (Mar 2014) ISSN: 1878-0539 [Electronic] Netherlands
• PMID: 24530059 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Topics

• Adult
• Carcinoma, Squamous Cell (pathology)
• Cell Transformation, Neoplastic
• Cicatrix (surgery)
• Female
• Free Tissue Flaps
• Humans
• Male
• Mandible (surgery)
• Masticatory Muscles (surgery)
• Middle Aged
• Mouth Neoplasms (pathology)
• Oral Submucous Fibrosis (complications, pathology, surgery)
• Reoperation
• Retrospective Studies
• Time Factors
• Trismus (etiology, surgery)
• Young Adult