The buccal mucosa graft (BMG) is the standard graft for reconstructive urology, but management of the donor site remains under debate. The authors compared postoperative oral adverse outcomes between management methods (closure, nonclosure, or xenograft-assisted closure).
A retrospective cohort study was conducted, enrolling patients treated at Harborview Medical Center, Seattle, Washington. The patients had a history of urethroplasty using a unilateral BMG, and the primary outcome variables were postoperative oral adverse outcomes, defined as subjective changes in mouth opening, smile, chewing, speech, intraoral bleeding, paresthesia, trismus, and infection. Multivariate and regression analyses were performed.
The sample was composed of 137 patients (95% male; mean age, 48 years). The mean surface areas of the BMG for closure, nonclosure, and xenograft were 1059, 1178, and 1228 mm2, respectively. Thirty-four patients completed the survey (7 closure, 17 nonclosure, and 10 xenograft). Multiple linear regression showed a significant difference between the 3 groups with respect to patient-reported chewing ability and trismus favoring xenograft at larger graft sizes (P < .01).
Xenograft-assisted closure may reduce long-term oral adverse outcomes associated with trismus and subjective changes in chewing, mouth opening, speaking, and smiling with larger grafts. In addition, limited postoperative patient education for oral rehabilitation exercises was noted.
Abbreviations:BMG (Buccal Mucosa Graft)
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- Does closure of the buccal mucosal graft bed matter? Results from a randomized controlled trial.Urology. 2014; 84: 1223-1227
- Treatment of long ureteric strictures with buccal mucosal grafts.BJU Int. 2010; 105: 1452-1455
- Long-term followup and deterioration rate of anterior substitution urethroplasty.J Urol. 2014; 192: 808-813
- Substitution urethroplasty for anterior urethral stricture repair: comparison between lingual mucosa graft and pedicled skin flap.Scand J Urol. 2017; 51: 479-483
- Long-term outcomes of urethroplasty with abdominal wall skin grafts.Urology. 2015; 85: 258-262
- Long-term results of small intestinal submucosa graft in bulbar urethral reconstruction.Urology. 2012; 79: 695-701
- Long-term followup of bladder mucosa graft for male urethral reconstruction.J Urol. 1994; 151: 1056-1058
- A one-stage operation for hypospadias.Br J Surg. 1941; 29: 84-92
- Buccal mucosal urethroplasty: is it the new gold standard?.BJU Int. 2004; 93: 1191-1193
- Current controversies in anterior urethral stricture repair: free-graft versus pedicled skin-flap reconstruction.World J Urol. 1998; 16: 175-180
- Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: current topics and reviews.Int J Urol. 2017; 24: 493-503
- Graft use in bulbar urethroplasty.Urol Clin North Am. 2017; 44: 39-47
- Buccal mucosa grafts in hypospadias surgery.Br J Urol. 1995; 76: 23-30
- Effect of wound closure on buccal mucosal graft harvest site morbidity: results of a randomized prospective trial.Urology. 2012; 79: 443-447
- Substitution urethroplasty with closure versus nonclosure of the buccal mucosa graft harvest site: a randomized controlled trial with a detailed analysis of oral pain and morbidity.Eur Urol. 2018; 73: 910-922
- Oral complications after buccal mucosal graft harvest for urethroplasty.BJU Int. 2004; 94: 867-869
- A randomized prospective trial of primary versus AlloDerm closure of buccal mucosal graft harvest site for substitution urethroplasty.Urology. 2010; 75: 695-700
- The morbidity of buccal mucosal graft harvest for urethroplasty and the effect of nonclosure of the graft harvest site on postoperative pain.J Urol. 2004; 172: 580-583
- Closure versus nonclosure of buccal mucosal graft harvest site: a prospective randomized study on post operative morbidity.Indian J Urol. 2009; 25: 72-75
- Criteria for trismus in head and neck oncology.Int J Oral Maxillofac Surg. 2006; 35: 337-342
- Quality of life and oral function in patients treated with radiation therapy for head and neck cancer.Head Neck. 2001; 23: 389-398
- Radiation-induced trismus in head and neck cancer patients.Support Care Cancer. 2008; 16: 305-309
- Mobilization regimens for the prevention of jaw hypomobility in the radiated patient: a comparison of three techniques.J Oral Maxillofac Surg. 1993; 51: 863-867
- A systematic review of trismus induced by cancer therapies in head and neck cancer patients.Support Care Cancer. 2010; 18: 1033-1038
- TheraBite exercises to treat trismus secondary to head and neck cancer.Support Care Cancer. 2013; 21: 951-957
- Effects of topical oral antiseptic rinses on bacterial counts of saliva in healthy human subjects.Otolaryngol Head Neck Surg. 1998; 118: 625-629
Oral Cancer Foundation. Trismus. Available at: https://oralcancerfoundation.org/complications/trismus. Accessed April 1, 2021.
Published online: March 28, 2022
Accepted: March 24, 2022
Received in revised form: February 21, 2022
Received: October 26, 2021
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