Release and free flap reconstruction for trismus that develops after previous intraoral reconstruction

BACKGROUND: Oral cancer patients receive wide excision of oral structures and reconstruction of the intraoral defects with skin grafts and/or local, regional, or free flaps. Trismus is a common postoperative sequela, even without postoperative radiotherapy. Trismus decreases patients' quality of life and can have detrimental effects on their oral hygiene and nutritional status. METHODS: Between May of 1999 and June of 2003, 11 patients were operated on for release of trismus and reconstruction after previous intraoral reconstructions. The patients had been reconstructed with skin grafts (n = 4), radial forearm flaps (n = 3), anterolateral thigh flaps (n = 1), artificial dermis (n = 1), radial forearm flaps with skin grafts (n = 1), and pedicled pectoralis major flaps with skin grafts (n = 1). Eight patients had received postoperative radiotherapy. The patients presented with a mean interincisal distance of 3.1 mm (range, 0 to 10 mm). RESULTS: After trismus release, the intraoral soft-tissue defects were reconstructed with one or two free flaps (six anterolateral thigh flaps, nine forearm flaps, and one fibula osteoseptocutaneous flap). Fifteen of the 16 flaps were successful, with one flap failure. Average interincisal distance was 33.4 mm immediately after the release (range, 27 to 35 mm) and 18.9 mm (range, 5 to 30 mm) at a mean follow-up time of 22.7 months (16.1 mm in the radiated group and 26.3 mm in the nonradiated group). The mean amount of improvement was 15.8 mm. CONCLUSION: The use of free flaps to reconstruct the defects created after trismus release in patients with previous intraoral reconstruction is a viable option that yields reasonable, long-lasting improvements in mouth opening, intraoral hygiene, and quality of life.