A Systematic Review on Post-Operative Trismus Following Reconstruction of Oral Cavity Using Various Flaps

To evaluate effectiveness between various surgical modalities like free flap reconstruction (FFR) and coronoidectomy among patients with head and neck cancer.

Review was adhered Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020 and registered in PROSPERO-CRDXXXXX. Electronic databases were searched for randomized controlled trials (RCTs), prospective and retrospective studies evaluating the effectiveness between FFR and coronoidectomy in terms of trismus width release and maximum mouth opening (MMO) with a follow-up period of six months. Quality assessment of included studies was evaluated through Newcastle-Ottawa Scale (NOS). The standardized mean difference (SMD) was used as summary statistic measure with random effect model through Review manager (RevMan) version 5.3.

Four studies (3-retrospective and 1-prospective) fulfilled the eligibility criteria and were included in qualitative synthesis and for meta-analysis. All the included studies had presence of moderate to low risk of bias. Although both the surgical modalities were equally effective, meta-analysis showed that total trismus width loss on an average was 0.69 (-2.34 - 0.95) times reduced postoperatively through FFR, while coronoidectomy showed total trismus width loss of 0.24 (- 1.00 - 0.52) (p > 0.05). Funnel plot did not show the presence of any publication bias.

Both the surgical modalities were equally effective; however, FFR showed more overall mean reduction in total trismus width loss postoperatively. However, furthermore comparative and prospective studies with larger sample size and greater follow-up period with vigorous methodology and proper standardization should be conducted to validate these study findings.