上颌骨缺损可以通过假体闭塞来解决,自体组织重建,或两者的组合。然而,在最优方法的选择上仍然存在争议。因此,本研究的目的是系统回顾比较上颌肿瘤消融术后患者闭孔和皮瓣性能的证据。进行了电子和手动搜索方法,以确定合格的证据。两名审阅者独立评估了偏见的风险。此外,相同的审阅者独立地提取数据。使用Revman5.3进行荟萃分析,并进行最佳证据综合。纳入了16项研究,共分析了528名参与者。所有研究均以低质量进行评估。这项荟萃分析的结果表明,闭孔和皮瓣之间在单词清晰度(P=0.004)和咀嚼效率(P=0.002)方面的结果差异的证据较弱。然而,在语音清晰度和鼻音方面没有检测到差异。所有研究都被汇编成最佳证据综合。考虑了31个证据的总和。十二个证据被评估为中等水平,比如演讲,咀嚼,疼痛,流涎,味觉,张开嘴。除了单词清晰度的结果,咀嚼效率,嘴巴疼痛,其他中度证据显示闭塞器和皮瓣之间没有差异。总之,闭孔和皮瓣对上颌消融术后患者的康复功能可能有效。然而,与假肢康复相比,手术重建具有一些优势。在将这些结果应用于临床实践之前,还需要其他高质量的研究来提供更可靠的证据。
Maxillary defects can be resolved by prosthetic obturation, autologous tissue reconstruction, or a combination of both. However, there is still controversy in the selection of the optimal approach. Therefore, the aim of this study was to systematically review evidences comparing the performance of obturators and flaps in patients after maxillary oncological ablation. Both electronic and manual searching approaches were conducted to identify eligible evidence. Two reviewers independently assessed the risk of bias. In addition, the same reviewers independently extracted the data. Meta-analyses were performed using Revman 5.3, and best evidence synthesis was performed. Sixteen studies were included and a total of 528 participants were analyzed. All studies were assessed at low quality. Results of this meta-analysis showed weak evidence in the difference between obturators and flaps on the outcome regarding word intelligibility (P = 0.004) and masticatory efficiency (P = 0.002). However, no differences were detected regarding speech intelligibility and nasalance. All studies were compiled into the best evidence synthesis. The sum of 31 evidences was considered. Twelve evidences were evaluated at a moderate level, such as speech, mastication, pain, salivation, taste sensations, and mouth opening. Except the outcomes of word intelligibility, masticatory efficiency, and mouth pain, other moderate evidences showed no difference between obturators and flaps. In conclusion, both obturators and flaps might be effective in patients\' rehabilitation functions after maxillary ablation. However, some advantages were observed when using surgical reconstruction over prosthetic rehabilitation. Additional high-quality studies are needed to provide more solid evidence before applying these results into clinical practice.