Clinical value of reconstruction with a soft tissue graft versus reconstruction with an obturator alone after partial maxillectomy: A systematic review

Objective: The aim of this systematic review (SR) was to verify whether soft tissue graft reconstruction or prosthetic obturator reconstruction alone is more useful for defects after partial maxillectomy.Methods: We searched the MEDLINE, Cochrane CENTRAL, and Ichushi-Web databases to identify CPGs, SRs, randomized controlled trials (RCTs), and prospective and retrospective nonrandomized clinical (observational) studies according to preestablished criteria. We performed a statistical analysis using the Review Manager 5.4 software program and assessed the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.Results: One RCT, which included 60 subjects, was eligible. The analysis showed that the oral function and quality of life assessments favored graft reconstruction in seven outcomes (chewing, swallowing, speech, pain, taste, mood, and anxiety) and in favor of obturators in one (appearance). The assessment of treatment complications was not reported in the articles and could not be estimated. The risk of bias is serious because the assessment of the oral function and quality of life was judged by a subjective assessment, and the certainty of evidence was "low" for both the oral function and quality of life due to the small total sample size. Conclusions: We could not determine the superiority of reconstruction with soft tissue grafts versus obturators after partial maxillectomy because of the small number of studies and high risk of bias. Future multicenter data collection using measures that are as objective and universal as possible is desirable to better clarify the in-dications for graft reconstruction.