title: Free flap reconstruction after surgical release of oral submucous fibrosis: long-term maintenance and its clinical implications.
abstract: OBJECTIVE
  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: Department of Surgery, Queen Mary Hospital, Pokfulam Road, Hong Kong.
authors: Richie Chiu-Lung
authors: RC
authors: Chan
authors: Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Taipei, Taiwan. Electronic address: fuchanwei@gmail.com.
authors: Fu-Chan
authors: FC
authors: Wei
authors: Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Taipei, Taiwan.
authors: Chung-Kan
authors: CK
authors: Tsao
authors: Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Taipei, Taiwan.
authors: Huang-Kai
authors: HK
authors: Kao
authors: Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors: Yang-Ming
authors: YM
authors: Chang
authors: Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors: Chi-Ying
authors: CY
authors: Tsai
authors: Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors: Wen-Ho
authors: WH
authors: Chen
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D002471:Cell Transformation, Neoplastic; D002921:Cicatrix / Q000601:surgery; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008410:Masticatory Muscles / Q000601:surgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology*; D009914:Oral Submucous Fibrosis / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014313:Trismus / Q000209:etiology / Q000601:surgery; D055815:Young Adult
keywords: Malignant transformation; Oral cancer; Oral submucous fibrosis; Release; Submucous fibrosis