Surgical Approach of Trismus Caused by Oral Submucous Fibrosis and Evaluation of Buccal Mucosal Elasticity

口腔粘膜下纖維化引起牙關緊閉的手術方法及頰黏膜彈性的評估

沈仁翔(Jen-Hsiang Shen) ； 羅舜駿(Shun-Chun Lo) ； 蘇群琳(Chun-Lin Su) ； 張長正(Chang-Cheng Chang)

《臺灣整形外科醫學會雜誌》 29卷2期 (2020/06) Pp. 71-83

摘要

Background: Oral submucous fibrosis related trismus is a socially-handicapping condition and may compromise comprehensive oral examination for oral cancer. It is a global public health problem, especially in populations with habit of betel quid chewing. In advanced trismus cases, surgical release is indicated. The resultant buccal defect after fibrosis removal is not recommended for secondary healing. Different flap reconstruction approaches to the buccal defect were published and the effects are variable. Aim and Objectives: To review relevant studies in surgical release of trismus with different types of reconstruction and methods for measuring the improvement of trismus. Materials and Methods: A literature search was undertaken in PubMed and the Cochrane Database of Systematic Reviews with the aim of identifying all the peer reviewed, original research articles concerning trismus surgical and flap reconstruction in western and eastern countries published. Results: The types of tissues for reconstruction are divided into four types: extraoral grafts, extraoral flaps, intraoral flaps, and microvascular free flaps. Results in improvement of trismus and buccal mucosal elasticity are variable. Conclusion: The choice of appropriate flap for severe cases of trismus is essential in outcomes of postoperative mouth opening. Postoperative rehabilitation and stoppage of betel quid chewing habit are also imperative. With the new measurement technique for the improvement after trismus release, such as vestibular volumes by a pneumo-CT scanner, we can choose the more suitable flap for patients.

關鍵字

submucous fibrosis ； free flap transfer ； intra-oral volume evaluation

並列摘要

背景：口腔粘膜下纖維化引起之牙關緊閉會產生社交障礙，也可能影響口腔癌的相關口腔檢查，這對於咀嚼檳榔的人口是一個全球性的公共衛生問題。嚴重的牙關緊閉通常需要放鬆手術來治療，但術後產生的頰部缺損不適用於二次癒合，目前已有許多關於頰側缺損皮瓣重建方法，但其效果各有差異。目的及目標：文獻回顧不同牙關緊閉放鬆手術之重建方法及評估術後改善程度之方法。材料及方法：在PubMed和Cochrane資料庫中進行文獻檢索，搜尋所有包含東西方國家關於牙關緊閉手術和皮瓣重建的原著論文。結果：用於重建的組織類型分為四種類型：口外移植物，口外皮瓣，口內皮瓣和游離皮瓣。其術後牙關緊閉和頰粘膜彈性改善的程度各有不同。結論：對於嚴重的牙關緊閉，選擇合適的皮瓣對於術後張口的預後非常重要，同時術後復健和戒除檳榔也是必要的。使用新的測量技術評估牙關緊閉放鬆後的改善程度，例如以充氣電腦斷層評估口腔體積，我們可以為患者選擇更合適的皮瓣。