학술논문
Cirugía de liberación del trismus y reconstrucción microquirúrgica tras el tratamiento del cáncer oral y orofaringe
Document Type
Dissertation/Thesis
Author
Source
TDX (Tesis Doctorals en Xarxa)
Subject
Language
Spanish; Castilian
Abstract
INTRODUCCION: El trismus es una secuela con una incidencia considerable tras el tratamiento del cáncer de cabeza y cuello, repercutiendo sustancialmente en la calidad de vida de estos pacientes. Existe evidencia sobre su profilaxis y tratamiento principalmente mediante la rehabilitación, pero en muchos casos en estos pacientes no se consigue un tratamiento adecuado mediante técnicas conservadoras. Actualmente hay muy pocos estudios que exploren los resultados de la alternativa quirúrgica para tratar el trismus tras el tratamiento del cáncer oral y orofaringe. OBJETIVOS: Determinar los resultados de la cirugía de liberación de trismus y reconstrucción microquirúrgica tras el tratamiento del cáncer oral y orofaringe. Establecer los resultados inmediatos tras la cirugía y a largo plazo. MATERIAL Y METODOS: Estudio clínico retrospectivo de 40 pacientes con trismus en los que se realizó cirugía del trismus y reconstrucción microvascular. Se midió la distancia interincisal preoperatoria, intraoperatoria y de seguimiento. Calculamos la ganancia interincisal intraoperatoria y a largo plazo, así como la pérdida postoperatoria. Se realizó un análisis de los resultados a largo plazo con las variables preoperatorias e intraoperatorias. RESULTADOS: La liberación quirúrgica consiguió de forma inmediata aumentar la distancia interincisal 29,25mm. El 66,2% de esta distancia interincisal se perdió a causa de recidiva del trismus, siendo la ganancia interincisal a largo plazo de 9,90mm. La distancia interincisal de seguimiento media fue de 18,48mm. Las variables preoperatorias que presentaron peores resultados de forma significativa fueron pacientes con tumores avanzados, cirugía de maxilectomías previas o resecciones de piel y radioterapia previa . No existieron diferencias significativas en el resultado a largo plazo en función del tipo de liberación ni reconstrucción, a excepción de la reconstrucción con el colgajo sural que presentó peores resultados. Los pacientes con trismus ≤ 10mm podrían presentar más margen de beneficio con esta cirugía. CONCLUSIONES: Los resultados de esta cirugía para la corrección del trismus causado por el tratamiento del cáncer oral y orofaringe son moderados a largo plazo, presentando el trismus una alta tasa de recidiva a pesar de una cirugía agresiva. Los pacientes deben ser adecuadamente informados y seleccionados con cuidado.
INTRODUCTION: Trismus is a sequela with considerable incidence after the treatment of head and neck cancer, having a direct repercussion on the patient’s quality of life. There is evidence on its prophylaxis and treatment mainly with rehabilitation, but in many cases these patients will not achieve and adequate outcome with conservative management. Up to date there are very few studies that explore the results of a surgical treatment to treat patients with trismus after oral or oropharyngeal cancer. OBJECTIVES: Determine the results of trismus surgical release and free flap reconstruction after oral and oropharyngeal cancer. Establish the results immediately after surgery and determine the long-term results. MATERIAL AND METHODS: A retrospective clinical study was conducted including 40 patients with trismus after surgical release and microsurgical reconstruction. The preoperative, intraoperative and follow up interincisal distances were measured. The intraoperative and long-term interincisal gain was calculated, as well as the postoperative interincisal loss. An analysis of the long-term results with the preoperative and intraoperative variables was performed. RESULTS: Surgical release immediately increased the interincisal distance by 29,25mm. Sixty-six percent of this gain was lost in follow up due to trismus recurrence, giving a long-term interincisal gain of 9,90mm. The mean follow up interincisal distance was 18,48mm. The preoperative variables that presented significantly worse results were patients with high stage tumors, previous maxillectomies or 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 ≤ 10mm could have more room for improvement after this surgery. CONCLUSIONS: The results of this surgery for the correction of trismus caused by the treatment of oral and oropharyngeal cancer are moderate in the long term. Trismus has a high recurrence after the surgery in spite of aggressive treatment. Patients should be adequately counselled and carefully selected.
Universitat Autònoma de Barcelona. Programa de Doctorat en Cirurgia i Ciències Morfològiques
INTRODUCTION: Trismus is a sequela with considerable incidence after the treatment of head and neck cancer, having a direct repercussion on the patient’s quality of life. There is evidence on its prophylaxis and treatment mainly with rehabilitation, but in many cases these patients will not achieve and adequate outcome with conservative management. Up to date there are very few studies that explore the results of a surgical treatment to treat patients with trismus after oral or oropharyngeal cancer. OBJECTIVES: Determine the results of trismus surgical release and free flap reconstruction after oral and oropharyngeal cancer. Establish the results immediately after surgery and determine the long-term results. MATERIAL AND METHODS: A retrospective clinical study was conducted including 40 patients with trismus after surgical release and microsurgical reconstruction. The preoperative, intraoperative and follow up interincisal distances were measured. The intraoperative and long-term interincisal gain was calculated, as well as the postoperative interincisal loss. An analysis of the long-term results with the preoperative and intraoperative variables was performed. RESULTS: Surgical release immediately increased the interincisal distance by 29,25mm. Sixty-six percent of this gain was lost in follow up due to trismus recurrence, giving a long-term interincisal gain of 9,90mm. The mean follow up interincisal distance was 18,48mm. The preoperative variables that presented significantly worse results were patients with high stage tumors, previous maxillectomies or 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 ≤ 10mm could have more room for improvement after this surgery. CONCLUSIONS: The results of this surgery for the correction of trismus caused by the treatment of oral and oropharyngeal cancer are moderate in the long term. Trismus has a high recurrence after the surgery in spite of aggressive treatment. Patients should be adequately counselled and carefully selected.
Universitat Autònoma de Barcelona. Programa de Doctorat en Cirurgia i Ciències Morfològiques