A meta-analysis of prevalence of mouth opening restriction in patients with oral cancer

doi:10.3969/j.issn.1674-8115.2023.01.008

Abstract

Abstract:

Objective ·To study the prevalence of mouth opening restriction in oral cancer patients by meta-analysis. Methods ·China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journal Database (VIP), Wanfang Data (Wanfang), Chinese BioMedical Literature Database (CBM), PubMed, Ovid, EMbase, Cochrane Library, Web of Science/SciSearch, and ClinicalTrials.gov were searched for observational studies about the prevalence rate of restricted mouth opening in oral cancer patients (including prospective, retrospective, and cross-sectional studies). The time limit for retrieval was from the database establishment to April 30th, 2022. The obtained documents were independently screened and extracted according to the inclusion and exclusion criteria, and the literature quality evaluation was performed by using methodological index for non-randomized studies (MINORS). The data were combined with the mouth-opening-restricted prevalence rate as the outcome indicator, the meta-analysis was performed by using Stata 15.0 software, and the subgroup analysis was performed based on the detection time, tumor site, and tumor stage. The evidence quality of outcome indicators was evaluated by using GRADE profiler 3.6 software according to GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system. Results ·A total of 3 719 documents were obtained during the initial examination, and 18 documents were finally included, including 2 701 objects. The meta-analysis results showed that the total prevalence rate of mouth opening restriction in oral cancer patients was 42.7% (95%CI 27.0%?59.1%). The results of subgroup analysis showed that the prevalence rates of mouth opening restriction in patients with oral cancer before surgery, and 3 months, 6 months and 1 year or more after surgery were 29.6% (95%CI 9.0%?55.8%), 75.2% (95%CI 68.3%?81.5%), 59.1% (95%CI 38.8%?77.9%) and 22.3% (95%CI 2.0%?54.3%), respectively. The prevalence rates of mouth opening restriction in patients with oral cancer at T1?T2 stage and T3?T4 stage were 38.6% (95%CI 26.0%?52.0%) and 99.6% (95%CI 93.9%?100.0%) respectively. The prevalence rates of mouth opening restriction in patients with oral cancer in the retromolar triangle, the gingiva, the tongue, the salivary gland, the floor of mouth and the lip were 93.1% (95%CI 68.5%?100.0%), 68.1% (95%CI 52.9%?81.7%), 46.1% (95%CI 11.6%?82.7%), 26.1% (95%CI 15.9%?37.5%), 21.9% (95%CI 0.7%?54.0%), and 3.1% (95%CI 0?9.3%), respectively. The GRADE system for evidence quality grading indicated that the quality of evidence for outcome indicator was extremely low. Conclusion ·The total prevalence rate of mouth opening restriction in patients with oral cancer is high, nearly 50%; the patients at 3 months after surgery, at 6 months after surgery, at T3?T4 stage or whose tumor located in the retromolar triangle have higher prevalence rates.

Key words: oral neoplasm, mouth opening restriction, prevalence, meta-analysis

CLC Number:

R739.8

YANG Ling, HOU Lili, ZHAO Yan, CHEN Weihong, ZHANG Jinfeng, MAO Yan. A meta-analysis of prevalence of mouth opening restriction in patients with oral cancer[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(1): 61-69.

Figures/Tables 7

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References 41

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Study	Research type	Population	n	Outcome index
FU， et al （2014）^［10］	Prospective study	Oral cancer patients	104	①②
GONDIVKAR， et al （2021）^［11］	Prospective study	Oral cancer patients	100	①②③④
MARTINS， et al （2020）^［12］	Prosepctive study	Oral cancer patients	35	①③
PANTVAIDYA， et al （2019）^［13］	Prosepctive study	Oral cancer patients	401	①②
AGARWAL， et al （2016）^［14］	Prosepctive study	Oral cancer patients	30	②③④
MINHAS， et al （2017）^［15］	Cross-sectional study	Patients with oral squamous cell carcinoma	81	①
OWOSHO， et al （2016）^［16］	Retrospectivel study	Oral cancer patients	54	①③
SCOTT， et al （2011）^［17］	Prosepctive study	Oral cancer patients	98	②
WETZELS， et al （2014）^［18］	Prospective study	Oral cancer patients	143	②
HSIEH， et al （2014）^［19］	Prospective study	Patients with oral squamous cell carcinoma	22	①
VAN DER GEER， et al （2019）^［20］	Cross-sectional study	Oral cancer patients	730	③
STEINER， et al （2015）^［21］	Prospective study	Oral cancer patients	45	①
ASTRADSSON， et al （2018）^［22］	Prospective study	Oral cancer patients	27	①②
JOHNSON， et al （2010）^［3］	Prospective study	Oral cancer patients	246	③
PEI-LING， et al （2019）^［23］	Cross-sectional study	Oral cancer patients	69	②
BATISTA， et al （2017）^［24］	Prospective study	Oral cancer patients	100	①
NIKHAR， et al （2017）^［25］	Prospective study	Oral cancer patients	156	①
MISHRA， et al （2005）^［26］	Prospective study	Oral cancer patients	260	①

Study	Research type	Population	n	Outcome index
FU， et al （2014）^［10］	Prospective study	Oral cancer patients	104	①②
GONDIVKAR， et al （2021）^［11］	Prospective study	Oral cancer patients	100	①②③④
MARTINS， et al （2020）^［12］	Prosepctive study	Oral cancer patients	35	①③
PANTVAIDYA， et al （2019）^［13］	Prosepctive study	Oral cancer patients	401	①②
AGARWAL， et al （2016）^［14］	Prosepctive study	Oral cancer patients	30	②③④
MINHAS， et al （2017）^［15］	Cross-sectional study	Patients with oral squamous cell carcinoma	81	①
OWOSHO， et al （2016）^［16］	Retrospectivel study	Oral cancer patients	54	①③
SCOTT， et al （2011）^［17］	Prosepctive study	Oral cancer patients	98	②
WETZELS， et al （2014）^［18］	Prospective study	Oral cancer patients	143	②
HSIEH， et al （2014）^［19］	Prospective study	Patients with oral squamous cell carcinoma	22	①
VAN DER GEER， et al （2019）^［20］	Cross-sectional study	Oral cancer patients	730	③
STEINER， et al （2015）^［21］	Prospective study	Oral cancer patients	45	①
ASTRADSSON， et al （2018）^［22］	Prospective study	Oral cancer patients	27	①②
JOHNSON， et al （2010）^［3］	Prospective study	Oral cancer patients	246	③
PEI-LING， et al （2019）^［23］	Cross-sectional study	Oral cancer patients	69	②
BATISTA， et al （2017）^［24］	Prospective study	Oral cancer patients	100	①
NIKHAR， et al （2017）^［25］	Prospective study	Oral cancer patients	156	①
MISHRA， et al （2005）^［26］	Prospective study	Oral cancer patients	260	①

Study	Score of item/point								Total score of MINORS/point
Study	①	②	③	④	⑤	⑥	⑦	⑧	Total score of MINORS/point
FU， et al （2014）^［10］	2	2	2	2	0	2	2	0	12
GONDIVKAR， et al （2021）^［11］	2	2	2	2	0	0	2	2	12
MARTINS， et al （2020）^［12］	2	2	2	2	0	2	2	0	12
PANTVAIDYA， et al （2019）^［13］	2	2	2	2	0	2	2	0	12
AGARWAL， et al （2016）^［14］	2	2	2	2	0	2	2	0	12
MINHAS， et al （2017）^［15］	2	2	2	2	0	2	2	0	12
OWOSHO， et al （2016）^［16］	2	2	2	2	0	0	2	2	12
SCOTT， et al （2011）^［17］	2	2	2	2	0	2	2	0	12
WETZELS， et al （2014）^［18］	2	2	2	2	0	2	2	0	12
HSIEH， et al （2014）^［19］	2	2	2	2	0	2	2	0	12
VAN DER GEER， et al （2019）^［20］	2	2	2	2	0	2	2	0	12
STEINER， et al （2015）^［21］	2	2	2	2	0	2	2	0	12
ASTRADSSON， et al （2018）^［22］	2	0	2	2	0	0	2	2	10
JOHNSON， et al （2010）^［3］	2	2	2	2	0	2	2	0	12
PEI-LING， et al （2019）^［23］	2	2	2	2	0	2	2	0	12
BATISTA， et al （2017）^［24］	2	2	2	2	0	0	0	0	8
NIKHAR， et al （2017）^［25］	2	2	2	2	0	2	2	0	12
MISHRA， et al （2005）^［26］	2	2	2	2	0	2	2	0	12

Study	Score of item/point								Total score of MINORS/point
Study	①	②	③	④	⑤	⑥	⑦	⑧	Total score of MINORS/point
FU， et al （2014）^［10］	2	2	2	2	0	2	2	0	12
GONDIVKAR， et al （2021）^［11］	2	2	2	2	0	0	2	2	12
MARTINS， et al （2020）^［12］	2	2	2	2	0	2	2	0	12
PANTVAIDYA， et al （2019）^［13］	2	2	2	2	0	2	2	0	12
AGARWAL， et al （2016）^［14］	2	2	2	2	0	2	2	0	12
MINHAS， et al （2017）^［15］	2	2	2	2	0	2	2	0	12
OWOSHO， et al （2016）^［16］	2	2	2	2	0	0	2	2	12
SCOTT， et al （2011）^［17］	2	2	2	2	0	2	2	0	12
WETZELS， et al （2014）^［18］	2	2	2	2	0	2	2	0	12
HSIEH， et al （2014）^［19］	2	2	2	2	0	2	2	0	12
VAN DER GEER， et al （2019）^［20］	2	2	2	2	0	2	2	0	12
STEINER， et al （2015）^［21］	2	2	2	2	0	2	2	0	12
ASTRADSSON， et al （2018）^［22］	2	0	2	2	0	0	2	2	10
JOHNSON， et al （2010）^［3］	2	2	2	2	0	2	2	0	12
PEI-LING， et al （2019）^［23］	2	2	2	2	0	2	2	0	12
BATISTA， et al （2017）^［24］	2	2	2	2	0	0	0	0	8
NIKHAR， et al （2017）^［25］	2	2	2	2	0	2	2	0	12
MISHRA， et al （2005）^［26］	2	2	2	2	0	2	2	0	12

Subgroup	Study/n	I²/%	P value	Effects model	Mouth opening restriction rate （95%CI）/%
Time
Before surgery	5	96.2	0.000	Random	29.6 （9.0‒55.8）
3 months after surgery	2	0	0.000	Fixed	75.2 （68.3‒81.5）
6 months after surgery	5	94.7	0.000	Random	59.1 （38.8‒77.9）
1 year or above after surgery	3	95.7	0.000	Random	22.3 （2.0‒54.3）
Tumor stage
T1‒T2 phase	2	0	0.000	Fixed	38.6 （26.0‒52.0）
T3‒T4 phase	2	0	0.000	Fixed	99.6 （93.9‒100.0）
Tumor site
Retromolar triangle	2	0	0.000	Fixed	93.1 （68.5‒100.0）
Gingiva	2	0	0.000	Fixed	68.1 （52.9‒81.7）
Tongue	5	92.8	0.000	Random	46.1 （11.6‒82.7）
Salivary glands	2	0	0.000	Fixed	26.1 （15.9‒37.5）
Mouth floor	4	53.2	0.093	Random	21.9 （0.7‒54.0）
Lip	4	0	0.465	Fixed	3.1 （0‒9.3）