Oral complications after buccal mucosal graft harvest for urethroplasty

Abstract

RESULTS Thirty-five patients were identified but only 30 (mean age 48.3 years, range 24 – 86) could be contacted; they had had 31 operations. Soon after surgery (the first 48 h), 22 (73%) of the patients had little or no oral pain; 70% and 90% of the patients were able to eat and drink, respectively; 59% complained of numbness and 75% complained of tightness of the mouth. At discharge 6 days after surgery 90% of patients had little or no oral pain and all were able to eat and drink, but 10% had moderate-to-severe oral pain, 39% had oral numbness, and 52% had tightness of the mouth. At the time of interview, 16% of patients had oral numbness (mean duration 13.6 months) and 32% had tightness of the mouth (mean duration 20.9 months). In answer to the question of whether they would have their cheek mucosa harvested again if required, 74% responded ‘yes’, 3% ‘no’, and 23% had mixed feelings. CONCLUSIONS BMG harvesting is a good operation, as most patients were satisfied, but it is not without long-term complications and patients should be adequately informed. Editorial Comment: Buccal mucosal grafting has been established as an important tool in the hypospadiology armamentarium, particularly when used in a staged repair where the initial stage includes covering the urethral plate with buccal mucosa followed months later with a closure of the neourethra. As urologists, we tend to focus less on the potential complications associated with harvesting the buccal mucosal graft than we do on the complications following the urethroplasty. This sample, taken primarily from the adult population, reminds us that there is morbidity associated with the harvest and healing of the buccal mucosal graft. In this series there was persistent numbness as far out as 1 year for 16% of the patients, and 32% had persistent “tightness” of the mouth. In all cases the surgeons closed the graft site following the harvest. Not all surgeons close the oral mucosa to avoid an oral wound contracture. However, this article reminds us of the importance of reviewing these potential complications with the patient or his or her family when considering this approach for a major urethral reconstruction. Douglas A. Canning, M.D.