Oral Mucosa

  • Introduction
  • Lectures
  • Articles
  • F.A.Q.
  • Results
  • Questionnaire
  • Surgical Techniques
The surgical technique of “Harvesting oral mucosa from the mouth” is made by harvesting a strip of oral mucosa from the mouth.
There are two basic types of Harvesting oral mucosa from the mouth:

  • Harvesting the oral mucosal graft from the cheek. Using this technique, the oral graft is harvested from the internal surface of the cheek (figures 1,2,3,4). This procedure is the most frequent technique used in our Center.
  • Harvesting the oral mucosal graft from the tongue. Using this technique, the oral graft is harvested from the ventral surface of the tongue (figures 5,6,7,8,9). This procedure is used when the harvesting from the cheek is not possible.

The surgical technique of Harvesting oral mucosa from the mouth is generally suggested in the following case:

  • patients with penile or bulbar urethral strictures, requiring an augmented urethroplasty using a substitute material.

In some patients may be necessary to harvest two grafts from the mouth (figure 10). The harvesting procedure of oral mucosa from the mouth is free of complications and the patient satisfaction and acceptance of this procedure is high, as we investigated using using a questionnaire in 350 patients. (see questionnaire)

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Figure 10

Lecture n° 1:

Urethral stricture surgery – tips and tricks. Surgery of the bulbar urethra
Joint Meeting of the ESAU and the ESGURS
October 25 – 27, 2007
Madrid – Spain
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Lecture n° 2:
Evaluation of early, late complications and patient satisfaction in 300 patients who underwent oral graft harvesting from a single cheek using a standard technique in a referral center experience
AUA 2009
Chicago, Illinois – USA
April 25 – 30, 2009
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Lecture n° 3:
One-stage substitution urethroplasty
24th Annual EAU Congress
Stockholm – Sweden
March 17 – 21, 2009
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Lecture n° 4:
The Use of Oral Mucosa for Anterior Urethroplasty
Training Course on “Techniques in Reconstructive Urology”
Mansoura – Egypy
January 23 – 29, 2010
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Article n° 1
Guido Barbagli, Michele De Angelis, Giuseppe Romano, Pier Guido Ciabatti, Massimo Lazzeri,
The Use of Lingual Mucosal Graft in Adult Anterior Urethroplasty: Surgical Steps and Short-Term Outcome
Eur Urol 2008; 54:671 – 676

Objective: Investigate the tolerability, safety, and efficacy of using the lingual mucosal graft (LMG) for anterior urethroplasty.
Methods: Ten patients (average age, 41 yr) underwent substitution urethroplasty LMG. Harvesting the graft from the tongue was performed by either the oral surgeon or the urologist. In five patients with penile urethral strictures, the grafts were placed on the dorsal urethral surface as a “dorsal inlay.” In five patients with bulbar urethral strictures, the grafts were used as a “dorsal inlay” (3 cases) or “ventral onlay” (2 cases). The average follow-up was 5 mo (range: 3–12 mo)..
Results: Nine cases (90%) were successful and one (10%) was a failure. Three patients who underwent bulbar urethroplasty showed prior failed repair using buccal mucosal grafts harvested from a single cheek (1 case), from both cheeks (1 case), or from the lip (1 case). The length of the lingual grafts was 4–6cm (mean: 4.5cm) with a width of 2.5cm. No patient developed early or late postoperative complications on the harvest site related to the tongue surgery. No difference was observed in patients in whom the graft harvesting was performed by the oral surgeon compared to the patients in whom the procedure was performed by the urologist..
Conclusions: The surgical technique for harvesting a graft from the tongue is simple and safe. The tongue may be the best alternative donor site to the lip when a thin graft is required for urethroplasty or when the cheek harvesting is not possible.

Article n° 2
Lu-Jie Song; Yue-Min Xu; Massimo Lazzeri; Guido Barbagli
Lingual mucosal grafts for anterior urethroplasty: a review
BJU International, 2009: 104, 1052-1056

We critically reviewed recent reports of lingual mucosal grafts (LMGs) for substitution urethroplasty, to determine the efficacy and complications of this approach. Only a few centres have published the short or interim outcome of LMG urethroplasty. These studies dealt mainly with surgical techniques and harvesting LMGs, emphasizing the comparison of different intra-oral donor sites. The preliminary results seem to be encouraging for the safety and efficacy of LMG urethroplasty. When compared with other substitute materials, LMG give equally good results with much easier harvesting and minimal donor site morbidity. Thus, lingual mucosa is most likely to become an alternative to oral mucosa for substitution urethroplasty and longer term results of its use are awaited with interest.

Article n° 3
Barbagli G, Vallasciani S, Romano G, Fabbri F, Guazzoni G, Lazzeri M.
Morbidity of Oral Mucosa Graft Harvesting from a Single Cheek
Eur Urol, 2010: 58, 33 – 41

Background: The oral mucosa (OM) is a popular substitute for urethroplasty.
Objective: The aim of this study was to investigate oral morbidity and patient satisfaction in a homogeneous group of patients who underwent OM harvesting.
Design, Setting, and Participants: This study is a prospective analysis of 350 patients who underwent OM harvesting from a single cheek.
Intervention: The graft was harvested in an ovoid shape with closure of the wound. Standard graft size was 4cm in length and 2.5cm in width.
Measurements: Self-administered, nonvalidated semiquantitative (0, absence of complications or symptoms; 3, the worst complication or symptom) questionnaire consisting of six questions was used to investigate early complications, with 13 questions designed to investigate late complications and patient satisfaction.
Results and limitations: Early complications included bleeding, which occurred in 15 patients (4.3%); two patients required immediate surgical revision of the harvesting site. The majority of patients (85.2%) showed no pain, and only 3.7% of patients required use of anti-inflammatory drugs. The majority of patients (65.8%) showed slight or moderate swelling. With respect to late complications, most of the patients (73.4%) reported oral numbness for 1 wk, 22.9% for 1 mo, and 3.77% for 3 mo. Numbness resulting from scarring was absent or slight in most of patients. Changes in oral sensitivity occurred in 2.3% of patients. No difficulties opening the mouth or smiling was found in 98.3% and 99.7% of patients, respectively. Slight or moderate dry mouth was found in 97.1% of patients. In response to the question, “Would you undergo oral mucosa graft harvesting using this technique again,” 343 patients (98%) replied “yes,” and 7 patients (2%) replied “no.”
Conclusions: The harvesting of an OM ovoid graft from a cheek with closure of the wound is a safe procedure with a high patient satisfaction rate.

Article n° 4
Guido Barbagli , Salvatore Sansalone , Giuseppe Romano and Massimo Lazzeri
Ventral onlay oral mucosal graft bulbar urethroplasty
BJU Int 2011; 108: 1218-1231

The current surgical approach to the uncomplicated bulbar urethral stricture began in 1993 when El-Kasaby et al . described the repair of anterior urethral strictures using an oral mucosa graft, including eight patients who underwent bulbar urethroplasty. In 1996, Morey and McAninch first described ventral onlay oral mucosa urethroplasty, suggesting suturing of the oral graft in the ventral surface of the urethra. In 1996, Barbagli et al . described the dorsal free-graft urethroplasty, suggesting suturing the graft in the dorsal surface of the urethra, over the albuginea of the underlying corpora cavernosa. The location of the graft on the ventral or dorsal urethral surface has become a contentious issue, dating from the time these two techniques were described. Success with bulbar oral mucosal grafts has been high with dorsal or ventral graft location and the different graft positions have shown no differences in success rates. Recently, we developed a new muscle and nerve-sparing bulbar urethroplasty, avoiding fully opening the bulbo-spongiosum muscle, thus better preserving ejaculatory function. The selection of a surgical technique for bulbar urethra reconstruction, in addition to respecting the status of the genitalia tissue and components, must also be based on the proper anatomical characteristics of the bulbar urethra, to ensure graft take and survival. Further, sexual function can be placed at risk by any surgery on the genitalia, and dissection must avoid interference with the neurovascular supply to the penis and genitalia. Bulbar urethroplasty using grafts should not compromise penile length or cause penile chordee, and certainly should not untowardly affect penile and genitalia appearance.

Article n° 5
Guido Barbagli, Salvatore Sansalone, Massimo Lazzeri
Oral Mucosa and Urethroplasty: It’s Time to Change
EUROPEAN UROLOGY 6 2 ( 2 0 1 2 ) 1 0 7 1 – 1 0 7 5

In this issue of European Urology, Kero and colleagues reported on the Finnish Family HPV Study, a longitudinal cohort study looking at the prevalence and incidence of oral human papillomavirus (HPV) infection in healthy men followed for 7 yr [1]. The most relevant findings they reported were a high prevalence of male oral HPV, ranging from15% to 31%, and the confirmation that themost frequent genotype was HPV-16. In their conclusion, they advise the reader that oral mucosa is an important reservoir for the virus. These data raise the following questions, which we will address below: (1) What does oral mucosa HPV infection have to do with urology? (2) Why should European Urology readers be interested in it? (3) What was the European Urology editor thinking when he decided to cover this topic?.
1. Question: Can the surgical procedure be performed with full coverage by the National Health Care System?
Answer: Yes.

2. Question: What kind of anesthesia is used for this surgery?
Answer: General anesthesia with nasal tube.

3. Question: How many hours does the surgery take?
Answer: Harvesting oral mucosa from the cheek takes about ½ hour.

4. Question: Are there any risks concerning chewing, flow of saliva and face physiognomy after the surgery?
Answer: No, there aren’t.

5. Question: How many days of hospital recovery are expected following the surgery?
Answer: Urethroplasty using oral mucosa requires from 5 to 7 days in hospital.

6. Question: Is it painful to harvest oral mucosa from the cheek?
Answer: No, it isn’t. Only 3.7% of patients required anti-inflammatory pain killers for oral pain.

7. Question: How many days shall I wait before resuming a normal diet?
Answer: The patient initially consumes a clear liquid diet and ice cream before advancing to a soft and then regular diet.

8. Question: Are there any food to avoid during the convalescence?
Answer: Very hot food.

9. Question: Can I resume eating normally after surgery?
Answer: All patients resumed eating normally after surgery within one month.

10. Question: Are there any risks such as dry mouth, difficulty at opening the mouth or swelling after eating, problems at smiling?
Answer: No, there aren’t.


Results on 350 patients
Barbagli G. et al, Eur Urol, 2010: 58,33 – 41


1. Did you suffer from bothersome bleeding during the three days following oral mucosa harvesting?

Yes 4.3%
No 95.7%

2. How would you score the oral pain during the three days following oral mucosa harvesting?

No pain 49.2%
Slight 36%
Moderate 13.7%
Severe 1.1%

3. How would you score the oral swelling during the three following oral mucosa harvesting?

No swelling 33.7%
Slight 41.2%
Moderate 24.6%
Severe 0.5%

4. Following surgery, when did you resume a normal diet?

After 3 days 58.6%
After 6 days 31.4%
After 10 days 10%

5. What bothered you most during the early post-operative period?

The oral wound 27.7%
The perineal wound 52.6%
Both 1.4%
Neither 18.3%

6. Did you take pain killers during the three days following oral mucosa harvesting?

Yes 3.7%
No 96.3%


1. How many days did oral numbness last after the surgery?

1 week 73.4%
1 month 22.9%
3 months 3.7%

2. How would you rate the numbness experienced due to the oral stitches?

No numbness 48%
Slight 40.3%
Moderate 10.9%
Severe 0.8%

3. Following surgery, how many months did the oral numbness last due to the stitches?

1 month 93.9%
2 months 4.4%
3 months 1.7%

4. How would you score the numbness experienced due to the oral scar?

No numbness 82.8%
Slight 14.6%
Moderate 2.6%
Severe 0%

5. Did you suffer from oral infection following the surgery?

Yes 1.7%
No 98.3%

6. After some months following the surgery, do you have:

Changes in oral sensitivity/sensibility/sensory perception 2.3%
Oral numbness 10.3%
Mouth pain 0%
No problems 87.4%

7. After some months following the surgery, do you have difficulties opening your mouth?

No 98.3%
Slight 1.4%
Moderate 0.3%
Severe 0%

8. After some months following the surgery, do you have problems smiling?

No 99.7%
Slight 0.3%
Moderate 0%
Severe 0%

9. After some months following the surgery, do you have dry mouth?

No 97.1%
Slight 2.6%
Moderate 0.3%
Severe 0%

10. After some months following the surgery, do you have oral swelling after eating?

No 98.3%
Slight 1.7%
Moderate 0%
Severe 0%

11. Did you resume eating normally following the surgery?

Yes 100%
No 0%

12. How much time passed before resuming a normal diet?

Up to 1 month 94%
2 months 4.3%
3 months 1.7%

13. Would you undergo oral mucosa graft harvesting using this technique again?

Yes 98%
No 2%

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Harvesting oral mucosal graft from the cheek:
Surgical technique: step by step

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Harvesting oral mucosal graft from the tongue:
Surgical technique: step by step