Role of Prophylactic Coronoidectomy in Oral Cancer Treatment: a Retrospective Cohort Study
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ORIGINAL ARTICLE
Role of Prophylactic Coronoidectomy in Oral Cancer Treatment: a Retrospective Cohort Study Lakshmi narayana G 1,2
&
Mani Chandrasekar 1
Received: 11 April 2020 / Accepted: 15 September 2020 # Indian Association of Surgical Oncology 2020
Abstract To evaluate the effectiveness of coronoidectomy to prevent trismus in patients undergoing primary surgery for oral cancer. Patients who underwent primary surgery for oral gingivo-buccal cancers were analysed. Group 1 (G1) consists of patients who underwent coronoidectomy during the primary ablative procedure and group 2 (G2) who underwent standard ablative surgery without coronoidectomy. Post-treatment maximum interincisor opening was compared between the two groups. Sixty-four patients were included, 31 in G1 and 33 patients in G2. Overall, 81% had reduction in mouth opening at the time of evaluation. The post-treatment mean mouth opening was 28.81 ± 8.2 and 22.30 ± 10.9 (p = .01) in G1 and G2, respectively. Amongst factors predisposing to trismus, patients with oral submucous fibrosis (p = .008) had reconstruction with microvascular free flap (p = .007), without post-operative radiotherapy (p = .01) and good patient compliance (p = .003) had significant benefit with simultaneous coronoidectomy. In the sub-group analysis in patients without OSMF and PORT, the mean reduction in mouth opening was significantly better in G1 (p = .04). Prophylactic coronoidectomy done at the time of primary surgery showed significant reduction in post-surgical trismus. Keywords Trismus . Prevention . Surgical . Head and neck cancer
Introduction Restricted mouth opening or trismus is well-recognised sequelae of oral cancer and its treatment. [1] The reported postoperative incidence of trismus varies from 54 to 79% in patients treated for head and neck cancers. [2–4] Post-treatment trismus affects the patient’s quality of life, impedes maintenance of good oral hygiene, causes nutritional deficits, interferes with postoperative cancer surveillance and causes difficulty in securing the airway. [4] The severity of trismus is influenced by various factors including extent of preoperative oral submucous fibrosis (OSMF), fibrosis associated with surgical healing and post-operative radiation. [5, 6] Posttreatment trismus is rapidly progressive and refractory to conventional treatment modalities, and warranting additional * Lakshmi narayana G [email protected] 1
Head and Neck Surgery and Oncology, Cancer Research and Relief Trust, Chennai, Tamil Nadu, India
2
Kumaran Hospital, No. 214, EVR Periyar Salai (PH Road), Kilpauk, Chennai, India
surgical procedures like coronoidectomy, condylotomy and in severe case even to the extent of mandibulectomy to improve the quality of life. Prevention involves various mechanical strategies, to incrementally widen the interincisor distance of which stacking tongue depressor sticks, cork screw device, Heister mouth stretcher, dyna splint and therabite systems are in routine practice. [7] The results of these physical therapies are highly
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