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Charters E, Loy J, Wu R, Cheng K, Dunn M, Davies S, Clark J. Pilot Study of Intensive Trismus Intervention Using Restorabite™ During Unilateral Adjuvant Radiation for Head and Neck Cancer. Dysphagia 2024:10.1007/s00455-024-10668-4. [PMID: 38366084 DOI: 10.1007/s00455-024-10668-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/02/2024] [Indexed: 02/18/2024]
Abstract
Trismus commonly arises after surgery for head and neck cancer (HNC) and its severity is potentiated by postoperative radiotherapy. While the benefit of trismus rehabilitation after surgery and radiotherapy is well established, the evidence during radiotherapy is less clear. This may be due to poor adherence to trismus exercises secondary to acute mucositis. This study assessed the feasibility of using a novel trismus device during adjuvant radiotherapy for HNC in patients with acute postoperative trismus. Prospective single-arm cohort feasibility study. Eligible patients had undergone surgery with curative intent for HNC, planned for adjuvant radiotherapy, and were suitable for trismus rehabilitation. Participants completed a 10-week exercise program using a novel jaw stretching device. Study outcomes were adherence, maximal incisal opening (MIO), and trismus-related function and quality of life scores, assessed at baseline, 10 weeks, and 6 months after commencing exercises. Nine patients diagnosed with trismus after primary surgery were recruited. The mean increase in MIO at 10 weeks was 7.8 mm (range -4 to 15 mm, p = 0.03), and at 6 months was 10.6 mm (range 1-26 mm, p = 0.03). Significant improvements were observed in trismus-related quality of life (Gothenburg Trismus Questionnaire; p = 0.04). Adherence to the exercises was 100% in week 1-2, 67% in weeks 3-6, and 100% at 10 weeks (1 month post radiation). This study demonstrates the feasibility of using a novel jaw stretching device during adjuvant radiotherapy. Further evaluation is warranted to assess the effectiveness of early intervention and prevention of trismus during HNC radiotherapy.Level of Evidence: IV.
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Affiliation(s)
- Emma Charters
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Sydney, NSW, 2050, Australia.
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Jamie Loy
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Sydney, NSW, 2050, Australia
| | - Raymond Wu
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Kai Cheng
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Sydney, NSW, 2050, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia
| | - Masako Dunn
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Sydney, NSW, 2050, Australia
| | - Sarah Davies
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Sydney, NSW, 2050, Australia
| | - Jonathan Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Sydney, NSW, 2050, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
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Sheth H, Pragya R, Kovale S, Deshpande M, Mistry R, Shreenivas A, Limaye S. Oral mucositis—case series of a rare adverse effect associated with immunotherapy. Support Care Cancer 2021; 29:4705-4709. [DOI: 10.1007/s00520-021-05993-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
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Rebholz H, Braun RJ, Ladage D, Knoll W, Kleber C, Hassel AW. Loss of Olfactory Function-Early Indicator for Covid-19, Other Viral Infections and Neurodegenerative Disorders. Front Neurol 2020; 11:569333. [PMID: 33193009 PMCID: PMC7649754 DOI: 10.3389/fneur.2020.569333] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022] Open
Abstract
The loss of the senses of smell (anosmia) and taste (ageusia) are rather common disorders, affecting up to 20% of the adult population. Yet, this condition has not received the attention it deserves, most probably because per se such a disorder is not life threatening. However, loss of olfactory function significantly reduces the quality of life of the affected patients, leading to dislike in food and insufficient, exaggerated or unbalanced food intake, unintentional exposure to toxins such as household gas, social isolation, depression, and an overall insecurity. Not only is olfactory dysfunction rather prevalent in the healthy population, it is, in many instances, also a correlate or an early indicator of a panoply of diseases. Importantly, olfactory dysfunction is linked to the two most prominent neurodegenerative disorders, Parkinson's disease and Alzheimer's disease. Anosmia and hyposmia (reduced sense of smell) affect a majority of patients years before the onset of cognitive or motor symptoms, establishing olfactory dysfunction as early biomarker that can enable earlier diagnosis and preventative treatments. In the current health crisis caused by SARS-CoV2, anosmia and dysgeusia as early-onset symptoms in virus-positive patients may prove to be highly relevant and crucial for pre-symptomatic Covid-19 detection from a public health perspective, preceding by days the more classical respiratory tract symptoms such as cough, tightness of the chest or fever. Thus, the olfactory system seems to be at the frontline of pathologic assault, be it through pathogens or insults that can lead to or at least associate with neurodegeneration. The aim of this review is to assemble current knowledge from different medical fields that all share a common denominator, olfactory/gustatory dysfunction, and to distill overarching etiologies and disease progression mechanisms.
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Affiliation(s)
- Heike Rebholz
- Center of Neurodegeneration, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, Université de Paris, Paris, France
- GHU Psychiatrie et Neurosciences, Paris, France
| | - Ralf J. Braun
- Center of Neurodegeneration, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
| | - Dennis Ladage
- Center of Chemistry and Physics of Materials, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
- Universitaetsklinikum Köln, Cologne, Germany
| | | | - Christoph Kleber
- Center of Chemistry and Physics of Materials, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
- Institute of Chemical Technology of Inorganic Materials, Johannes Kepler University Linz, Linz, Austria
| | - Achim W. Hassel
- Institute of Chemical Technology of Inorganic Materials, Johannes Kepler University Linz, Linz, Austria
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Rinstad T, Bergqvist B, Mattsson U. Follow‐up of need for dental treatment in 126 patients who have received radiation treatment to the head and neck region. Int J Dent Hyg 2019; 18:201-209. [DOI: 10.1111/idh.12426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/04/2019] [Accepted: 12/08/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Tamara Rinstad
- Clinic of Orofacial Medicine/Hospital Dentistry Central Hospital Karlstad Sweden
| | - Birgitta Bergqvist
- Clinic of Orofacial Medicine/Hospital Dentistry Central Hospital Karlstad Sweden
| | - Ulf Mattsson
- Clinic of Orofacial Medicine/Hospital Dentistry Central Hospital Karlstad Sweden
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Peralta-Mamani M, da Silva BM, da Silva Pinto AC, Rubira-Bullen IRF, Honório HM, Rubira CMF, da Silva Santos PS. Low-level laser therapy dosimetry most used for oral mucositis due to radiotherapy for head and neck cancer: a systematic review and meta-analysis. Crit Rev Oncol Hematol 2019; 138:14-23. [DOI: 10.1016/j.critrevonc.2019.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/04/2018] [Accepted: 03/20/2019] [Indexed: 12/18/2022] Open
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Riva G, Franco P, Provenzano E, Arcadipane F, Bartoli C, Lava P, Ricardi U, Pecorari G. Radiation-Induced Rhinitis: Cytological and Olfactory Changes. Am J Rhinol Allergy 2019; 33:153-161. [PMID: 30632393 DOI: 10.1177/1945892418822448] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Oral mucositis is a well-known adverse event of radiotherapy (RT) for head and neck cancer (HNC). Its nasal counterpart, the radiation-induced rhinitis, is poorly studied and considered in clinical practice. OBJECTIVE The aim of this observational study was to evaluate acute cytological and olfactory alterations during RT and their correlation with RT doses. METHODS Ten patients who underwent RT for HNC, excluding tumors of the nasal cavities, were evaluated with nasal scraping for cytological examination, Sniffin' Sticks test for olfactory assessment, and Nasal Obstruction Symptom Evaluation scale. The examinations were performed before (T0), at mid-course (T1), and at the end (T2) of RT. They were repeated 1 and 3 months after RT (T3 and T4). Mean dose (Dmean) and near maximum dose (D2%) to nasal cavities and inferior turbinates were used for correlation analyses. RESULTS Radiation-induced rhinitis was present in 70% of patients at T2, and it was still observed in 40% of cases after 3 months. Although olfactory function remained within the normal range at the evaluated times, a significant decrease in odor threshold and discrimination was observed during RT, which returned to baseline levels after RT. Nasal cytology showed a radiation-induced rhinitis with neutrophils and sometimes bacteria. Mucous and squamous cell metaplasia appeared in 10% of patients. Dmean and D2% to inferior turbinates were associated to neutrophilic rhinitis at T2, and D2% to inferior turbinates was correlated to mucous cell metaplasia at T2. CONCLUSIONS RT for HNC induces acute rhinitis that may persist after the completion of treatment and can affect patient's quality of life. Nasal cytology can help to choose the best treatment on an individual basis.
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Affiliation(s)
- Giuseppe Riva
- 1 Otorhinolaryngology Division, Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Erica Provenzano
- 1 Otorhinolaryngology Division, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francesca Arcadipane
- 3 Radiation Oncology, Department of Oncology, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Claudia Bartoli
- 4 Otorhinolaryngology Division, Maria Vittoria Hospital, Turin, Italy
| | - Paolo Lava
- 1 Otorhinolaryngology Division, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Umberto Ricardi
- 2 Radiation Oncology, Department of Oncology, University of Turin, Turin, Italy
| | - Giancarlo Pecorari
- 1 Otorhinolaryngology Division, Department of Surgical Sciences, University of Turin, Turin, Italy
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Marrafon CS, Matos LL, Simões-Zenari M, Cernea CR, Nemr K. Speech-language therapy program for mouth opening in patients with oral and oropharyngeal cancer undergoing adjuvant radiotherapy: a pilot study. Codas 2018; 30:e20160221. [PMID: 29694489 DOI: 10.1590/2317-1782/20182016221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 08/14/2017] [Indexed: 01/15/2023] Open
Abstract
Purpose Assess the effectiveness of an orofacial myofunctional therapeutic program in patients with oral or oropharyngeal cancer submitted to adjuvant radiotherapy through pre- and post-program comparison of maximum mandibular opening. Methods Prospective study involving five adult patients and five elderly patients postoperatively to oral cavity/oropharynx surgery who were awaiting the beginning of radiotherapy or had undergone fewer than five treatment sessions. The study participants had their maximum jaw opening measured using a sliding caliper at the beginning and end of the program. Two mobility exercises and three mandibular traction exercises were selected and weekly monitored presentially for 10 weeks. Descriptive data and pre- and post-therapy comparative measures were statistically analyzed using the Wilcoxon test. Results Ten patients (two women and eight men) with mean age of 58.4 years, median of 57.0 years, completed the therapeutic program. They presented mean maximum mandibular opening of 31.6 ± 11.7 and 36.4 ± 8.0 mm pre- and post-therapy, respectively (p =0.021). Conclusion The proposed orofacial myofunctional therapeutic program increased the maximum jaw opening of patients referred to adjuvant radiotherapy for oral cavity or oropharynx cancer treatment.
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Affiliation(s)
- Caroline Somera Marrafon
- Programa de Pós-graduação em Ciências da Reabilitação, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Marcia Simões-Zenari
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Claudio Roberto Cernea
- Disciplina de Cirurgia de Cabeça e Pescoço, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Katia Nemr
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Abstract
Oral cancer therapies are associated with orofacial complications that could result in dose-limiting cancer treatment and consequent suboptimal tumor control. Oral cancer treatment complications include oral mucositis, salivary gland hypofunction, odontogenic infections, pain, dermatitis, neurotoxicity, soft tissue fibrosis, trismus, osteoradionecrosis, and potential cancer recurrence. These complications significantly affect cancer survivorship, quality of life, and psychosocial status. Effective dental management of patients with oral cancer involves the coordination of care among several health care professionals before, during, and after cancer therapy. The goal is to minimize complications, and establish optimal quality of life for survivors.
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9
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Kamstra JI, van Leeuwen M, Roodenburg JLN, Dijkstra PU. Exercise therapy for trismus secondary to head and neck cancer: A systematic review. Head Neck 2017; 39:2352-2362. [PMID: 29044879 DOI: 10.1002/hed.24859] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 10/04/2015] [Accepted: 11/25/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Effects of exercise therapy for trismus secondary to head and neck cancer have not been reviewed systematically since 2004. METHODS Four databases were searched. The quality of observational studies and randomized controlled trials was assessed. RESULTS Two hundred eleven articles were found, 20 studies were included. A large variation in research methodology, stretching techniques, duration of stretch, and repetition of exercises was found. The overall quality was moderate. Five of the 8 preventive studies found that exercises during (chemo)radiotherapy could not prevent a reduction in mouth opening. In 4 therapeutic case studies, mouth opening increased between 17 and 24 mm. In 8 other therapeutic studies, mouth opening increased between -1.9 and 13.6 mm. No exercise therapy was clearly superior to the others. CONCLUSION Changes in mouth opening ranged considerably and no stretching technique was superior to others regarding either prevention or treatment of trismus. Clinical guidelines cannot be given based on this systematic review. © 2016 Wiley Periodicals, Inc. Head Neck 39: 160-169, 2017.
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Affiliation(s)
- Jolanda I Kamstra
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Marianne van Leeuwen
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jan L N Roodenburg
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Pieter U Dijkstra
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, The Netherlands
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Gerhard D, Sousa FJDSSD, Andraus RAC, Pardo PE, Nai GA, Neto HB, Messora MR, Maia LP. Probiotic therapy reduces inflammation and improves intestinal morphology in rats with induced oral mucositis. Braz Oral Res 2017; 31:e71. [PMID: 28678976 DOI: 10.1590/1807-3107bor-2017.vol31.0071] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 06/07/2017] [Indexed: 01/06/2023] Open
Abstract
The aim of the present study was to evaluate the effect of systemic administration of probiotics (PROB) on the progression of experimentally induced oral and intestinal mucositis in rats immunosuppressed by chemotherapy (5-fluorouracil: 5-FU). Twenty-four rats were divided into the following groups (n=6): GC (control), GPROB, G5FU and G5-FU/PROB. Groups GPROB and G5-FU/PROB received 1 g of probiotic incorporated into each 100 g of feed (Bacillus subtilis, Bifidobacterium bifidum, Enterococcus faecium and Lactobacilllus acidophilus), beginning 30 days before oral mucositis induction. Groups G5FU and G5-FU/PROB received 60 mg/kg of 5-FU on days 0 and 2. The left oral mucosa of each animal was irritated by mechanical trauma (days 1 and 2). On days 3 and 7, three animals from each group were sacrificed, and their oral mucosa and small intestine were biopsied and processed for histopathological analysis. Groups G5-FU and G5-FU/PROB showed ulcerated oral lesions at day 3, with progression in group G5-FU and regression in group G5-FU/PROB at day 7. Histologically, less severe signs of inflammation in the oral mucosa were observed in group G5-FU/PROB than in group G5-FU. Regarding the intestine, villus-related defects of lesser magnitude were observed in group G5-FU/PROB, compared with group G5-FU. Group GPROB showed greater villus height than group GC. It can be concluded that probiotic supplementation reduced oral and intestinal inflammation in immunosuppressed rats with experimentally induced mucositis, and may protect the intestine from changes induced by chemotherapy, thus contributing to overall health.
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Affiliation(s)
- Dayana Gerhard
- Universidade do Oeste Paulista - Unoeste, School of Dentistry, Presidente Prudente, SP, Brazil
| | | | | | - Paulo Eduardo Pardo
- Universidade do Oeste Paulista - Unoeste, Department of Veterinary Medicine, Presidente Prudente, SP, Brazil (retired)
| | - Gisele Alborguetti Nai
- Universidade do Oeste Paulista - Unoeste, Department of Pathology, Presidente Prudente, SP, Brazil
| | - Hermann Bremer Neto
- Universidade do Oeste Paulista - Unoeste, Department of Functional Sciences, Presidente Prudente, SP, Brazil
| | - Michel Reis Messora
- Universidade de São Paulo - USP, School of Dentistry of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Luciana Prado Maia
- Universidade do Oeste Paulista - Unoeste, Graduate Program in Dentistry, Presidente Prudente, SP, Brazil
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11
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Riva G, Sensini M, Corvino A, Pecorari G, Garzaro M. Smell and Taste Impairment After Total Laryngectomy. Ann Otol Rhinol Laryngol 2017; 126:548-554. [DOI: 10.1177/0003489417709794] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Aim of this observational study is the evaluation of olfactory and gustatory impairments in laryngectomized long-term survivors compared to control subjects. Correlation between smell and taste alterations, age, and previous adjuvant treatments in laryngectomees was investigated. Methods: Fifty control subjects and 50 patients who underwent total laryngectomy for advanced laryngeal carcinoma were evaluated. All subjects underwent symptoms evaluation, oropharyngeal exam, endoscopic fiberoptic nasal examination, and Taste Strips and Sniffin’ Sticks tests. Results: Hyposmia was reported by all laryngectomees and hypogeusia by 54% of patients. Sniffin’ Sticks and Taste Strips tests demonstrated a statistically significant difference between controls and laryngectomees regarding olfactory threshold, odor discrimination and identification, Threshold Discrimination Identification (TDI) score, and sour, salty, and gustatory Total Taste score ( P < .05). Multivariate analysis for Total Taste score in laryngectomees showed a statistically significant correlation with aging, having an odds ratio of 0.127 for age ≥65 years, but not with TDI score, radiotherapy, and follow-up time, whereas multivariate analysis for TDI score demonstrated no correlation with radiotherapy, age, and follow-up time. Conclusions: Total laryngectomy determines olfactory and gustatory impairments that should be taken into account in clinical practice. Relationships between sensorial alterations, aging, follow-up period, and adjuvant treatments should be further evaluated in prospective studies.
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Affiliation(s)
- Giuseppe Riva
- ENT Division, Surgical Sciences Department, University of Turin, Turin, Italy
| | - Matteo Sensini
- ENT Division, Surgical Sciences Department, University of Turin, Turin, Italy
| | - Andrea Corvino
- ENT Division, Surgical Sciences Department, University of Turin, Turin, Italy
| | - Giancarlo Pecorari
- ENT Division, Surgical Sciences Department, University of Turin, Turin, Italy
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Álvarez-Camacho M, Gonella S, Campbell S, Scrimger RA, Wismer WV. A systematic review of smell alterations after radiotherapy for head and neck cancer. Cancer Treat Rev 2017; 54:110-121. [PMID: 28242521 DOI: 10.1016/j.ctrv.2017.02.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/30/2017] [Accepted: 02/05/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To review the current knowledge on radiotherapy associated olfactory dysfunction among head and neck cancer (HNC) patients. METHODS A systematic review of RT-related olfactory dysfunction in HNC was performed. Searches were conducted in several databases (Medline, EMBASE, CINAHL, CAB Abstracts, SCOPUS, Proquest Dissertations and Theses, PROSPERO, ALLEBM Reviews - Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED). Publications investigating olfactory dysfunction as an explicit side effect of Radiotherapy (RT, or RT-chemo or RT-monoclonal antibodies) were eligible, no limits were applied. RESULTS Two hundred and twenty-nine papers were screened and 23 met inclusion criteria. CONCLUSIONS Odor detection, identification and discrimination are olfactory functions impaired after RT for HNC. An RT dose-effect has been calculated for odor identification and odor discrimination. There were no studies of the effect of olfactory dysfunction on weight loss or energy intake among RT-treated HNC patients. To improve our understanding of RT associated olfactory dysfunction among HNC patients, future studies should include a multi-dimensional assessment of olfactory function in a longitudinal design, track other conditions affecting olfaction, assess retronasal olfactory perception, adopt validated self-report tools and explore the impact of olfactory dysfunction on the eating experience of HNC patients.
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Affiliation(s)
- M Álvarez-Camacho
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - S Gonella
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, Italy
| | - S Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - R A Scrimger
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - W V Wismer
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada.
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Elad S, Zadik Y. Chronic oral mucositis after radiotherapy to the head and neck: a new insight. Support Care Cancer 2016; 24:4825-30. [PMID: 27475958 DOI: 10.1007/s00520-016-3337-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Oral mucositis is a major complication of anticancer therapy yet the literature focuses on immediate (acute) mucosal changes and hardly describes the chronic form. We aim to report the clinical manifestations of chronic mucositis. METHODS A retrospective chart review of oral mucositis referrals was performed. Inclusion/exclusion criteria defined the patients that were considered to have chronic mucositis. RESULTS Four female patients treated for tongue/lower lip squamous cell carcinoma were included. Extensive painful oral mucositis lesions developed in all patients during the course of radiotherapy, with ulcers remaining for 5-24 months after completion of therapy. We describe two presentations, namely the persistent form (long-lasting ulcers continuing from acute ulcers) and the recurrent form (new discrete ulcers appearing on atrophic mucosa following the completion of radiotherapy). CONCLUSIONS The long-term oral complications of radiotherapy to the head and neck may include chronic atrophic, erythematous, and/or ulcerated lesions. A diagnosis of chronic oral mucositis should be considered when the lesions are observed at least 3 months after radiotherapy, and other possible etiologies have been excluded. The influence of age and comorbidities (primarily diabetes mellitus) on chronic mucositis, the significance to patient's quality of life, and the management of chronic mucositis are important subjects for future research.
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Affiliation(s)
- Sharon Elad
- Division of Oral Medicine and Hospital General Dentistry, Eastman Institute for Oral Health, University of Rochester Medical Center, 625 Elmwood Ave, Rochester, NY, 14620, USA.,Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Yehuda Zadik
- Department of Oral Medicine, Oral and Maxillofacial Institute, Medical Corps, Israel Defense Forces, Tel Hashomer, Israel. .,Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, P.O.Box 12272, Jerusalem, 9112102, Israel.
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Dynasplint Trismus System exercises for trismus secondary to head and neck cancer: a prospective explorative study. Support Care Cancer 2016; 24:3315-23. [PMID: 26956713 PMCID: PMC4917584 DOI: 10.1007/s00520-016-3131-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/09/2016] [Indexed: 10/28/2022]
Abstract
PURPOSE The Dynasplint Trismus System (DTS) can be used to treat trismus secondary to head and neck cancer. We conducted a prospective study with the following aims: (1) to determine the effects of DTS exercises on changes in mouth opening, pain, mandibular function, quality of life (QoL), and symptomatology and (2) to analyze the patients' perception on DTS exercises, including user satisfaction, experiences, comfort, and compliance. METHODS The patients were instructed to exercise with the DTS for at least 16 weeks. Changes in mouth opening, pain, mandibular function, QoL, and symptomatology were evaluated, as well as the patients' perception of DTS exercises. RESULTS Eighteen consecutive patients were included. Baseline mouth opening was 22.6 mm (sd 7.6). After the patients completed the DTS exercise program, mouth opening increased (7.1 mm, sd 4.7) and perceived difficulty of opening the mouth improved significantly (p < 0.05). No significant effects were found in mandibular function, QoL, and overall symptomatology. The patients' perception was diverse. They reported effectiveness and positive feelings of the results and would recommend DTS exercises to other patients. About half of them thought DTS exercises were burdensome. CONCLUSIONS Mouth opening increased significantly after the DTS exercise program, relative to baseline. About one third of the gained increase was lost in the follow-up period. In general, the patients were satisfied about the effects and the DTS exercise program.
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15
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Kamstra JI, van Leeuwen M, Roodenburg JLN, Dijkstra PU. Exercise therapy for trismus secondary to head and neck cancer: A systematic review. Head Neck 2016; 39:160-169. [PMID: 26876238 DOI: 10.1002/hed.24366] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Effects of exercise therapy for trismus secondary to head and neck cancer have not been reviewed systematically since 2004. METHODS Four databases were searched. The quality of observational studies and randomized controlled trials was assessed. RESULTS Two hundred eleven articles were found, 20 studies were included. A large variation in research methodology, stretching techniques, duration of stretch, and repetition of exercises was found. The overall quality was moderate. Five of the 8 preventive studies found that exercises during (chemo)radiotherapy could not prevent a reduction in mouth opening. In 4 therapeutic case studies, mouth opening increased between 17 and 24 mm. In 8 other therapeutic studies, mouth opening increased between -1.9 and 13.6 mm. No exercise therapy was clearly superior to the others. CONCLUSION Changes in mouth opening ranged considerably and no stretching technique was superior to others regarding either prevention or treatment of trismus. Clinical guidelines cannot be given based on this systematic review. © 2016 Wiley Periodicals, Inc. Head Neck 39: 160-169, 2017.
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Affiliation(s)
- Jolanda I Kamstra
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Marianne van Leeuwen
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jan L N Roodenburg
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Pieter U Dijkstra
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, The Netherlands
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de Sá Ferreira EM, Soares LES, Antunes HS, Uemura ST, da Silva Barbosa P, Salmon HA, de Sant’Anna GR. Effect of therapeutic doses of radiotherapy on the organic and inorganic contents of the deciduous enamel: an in vitro study. Clin Oral Investig 2015; 20:1953-1961. [DOI: 10.1007/s00784-015-1686-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 12/01/2015] [Indexed: 11/28/2022]
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17
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Kamstra J, Dijkstra P, van Leeuwen M, Roodenburg J, Langendijk J. Mouth opening in patients irradiated for head and neck cancer: A prospective repeated measures study. Oral Oncol 2015; 51:548-55. [DOI: 10.1016/j.oraloncology.2015.01.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/26/2015] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
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Riva G, Raimondo L, Ravera M, Moretto F, Boita M, Potenza I, Rampino M, Ricardi U, Garzaro M. Late sensorial alterations in different radiotherapy techniques for nasopharyngeal cancer. Chem Senses 2015; 40:285-92. [PMID: 25800268 DOI: 10.1093/chemse/bjv011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Intensity-modulated radiation therapy (IMRT) for nasopharyngeal cancer (NPC) allowed a better distribution of the dose to the tumor volume, sparing surrounding structures. Aim of the study is the objective evaluation of olfactory and gustatory impairments in patients who underwent chemo-radiotherapy for NPC. Correlation between smell and taste alterations, xerostomy, and radiation technique was investigated. Thirty healthy subjects and 30 patients treated with chemo-radiation therapy for NPC, with at least a 2-years follow-up period, were evaluated. All subjects underwent symptoms evaluation, endoscopic fiber optic nasal examination, taste strips, Sniffin' sticks tests, Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer late radiation morbidity scoring system. Patients were divided in 2 groups: 2-dimensional radiotherapy/conformal 3-dimensional radiotherapy and IMRT. A higher percentage of rhinorrhea, nasal obstruction, xerostomy, hyposmia, hypogeusia, mucosal hyperemia, and presence of nasopharyngeal secretions was found in irradiated subjects (P < 0.05). Concerning olfactory and gustatory scores, we demonstrated a statistically significant difference between healthy subjects and irradiated patients (P < 0.05), with lower gustatory total score in IMRT group (P < 0.01). In conclusion, chemo-radiotherapy for NPC induces long-term smell and taste impairments, which can compromise quality of life. Although based on small samples, it is also important to consider that IMRT can induce higher taste dysfunction compared with traditional techniques.
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Affiliation(s)
- Giuseppe Riva
- 1st ENT Division, Department of Surgical Sciences, University of Turin, Turin 10126, Italy,
| | - Luca Raimondo
- 1st ENT Division, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Mattia Ravera
- 1st ENT Division, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Francesco Moretto
- Radiation Oncology Unit, Department of Oncology, University of Turin, Turin 10126, Italy, and
| | - Monica Boita
- Allergology and Clinical Immunology, Department of Medical Science, University of Turin, Turin 10126, Italy
| | - Ilenia Potenza
- Radiation Oncology Unit, Department of Oncology, University of Turin, Turin 10126, Italy, and
| | - Monica Rampino
- Radiation Oncology Unit, Department of Oncology, University of Turin, Turin 10126, Italy, and
| | - Umberto Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Turin, Turin 10126, Italy, and
| | - Massimiliano Garzaro
- 1st ENT Division, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
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SARI J, NASILOSKI KS, GOMES APN. Oral complications in patients receiving head and neck radiation therapy: a literature review. ACTA ACUST UNITED AC 2014. [DOI: 10.1590/1981-863720140004000007573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Oral cancer is a relatively common disease worldwide and its incidence rate has increased over the years. In Brazil, thousands of new cases emerge and the dental surgeon is the professional who diagnoses, prevents, intervenes in and instructs patients in regard to the disease, its treatment and related complications. There is no current form of systemic treatment able to destroy abnormal cells without causing harm or death to normal cells. Surgery combined with radiation is one of the most common treatments for malignant tumors in the head and neck. This modality of treatment has resulted in high rates of cure and survival. There are, however, severe side effects, causing morbidities and reducing patients' quality of life. Hence, this study's aim was to perform a literature review addressing the main complications arising form radiation therapy while emphasizing the conduct of dental surgeons in the face of these changes.
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Turner L, Mupparapu M, Akintoye SO. Review of the complications associated with treatment of oropharyngeal cancer: a guide for the dental practitioner. QUINTESSENCE INTERNATIONAL (BERLIN, GERMANY : 1985) 2014; 44:267-79. [PMID: 23444208 DOI: 10.3290/j.qi.a29050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Oropharyngeal cancer (OPC) is the sixth most common cancer worldwide. Focus on risk factors, improved diagnostic methods and effective management strategies have made it possible to successfully treat OPC. However, the 5-year survival rate has not improved for several years due to multiple treatment complications, tissue morbidity, loss of function, and diminished quality of life. Survivors are faced with complications like oral mucositis, hyposalivation, osteoradionecrosis, tissue fibrosis, morbidity from jaw resection, disfigurement, and loss of function that further diminish quality of life. The aim of this review is to highlight major complications associated with treatment of OPC via a literature search and review of available options for identification and management of these complications. DATA SOURCES Relevant publications on oral complications of OPC therapy were thoroughly reviewed from the literature published between the years 1988 and 2012. We evaluated reported incidence, prevalence, and risk factors for oral complications of chemotherapy and radiotherapy for OPC. The authors conducted an electronic search using English language databases, namely PubMed Plus, Medline (Pre-Medline and Medline), Cochrane Database of Systematic Reviews (evidence-based medicine), Dentistry & Oral Sciences Source, A ccessScience, Embase, Evidence-Based Medicine Reviews Multifile, Google Scholar, ISI Journal Citation Reports, and Ovid Multi-Database. CONCLUSION We identified the most common complications associated with the treatment of oral cancers. Based on the information gathered, there is evidence that survival of OPC extends beyond eradication of the diseased tissue. Understanding the potential treatment complications and utilizing available resources to prevent and minimize them are important. Caring for OPC survivors should be a multidisciplinary team approach involving the dentist, oncologist, internist, and social worker to improve the currently stagnant 5-year survival rate of OPC. More emphasis on improved quality of life after elimination of the cancer will ultimately improve OPC survivorship.
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The limitations of the clinical oral examination in detecting dysplastic oral lesions and oral squamous cell carcinoma. J Am Dent Assoc 2013. [PMID: 23204089 DOI: 10.14219/jada.archive.2012.0096] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The clinical oral examination (COE) is the criterion standard for the initial detection of oral lesions that harbor dysplasia or oral squamous cell carcinoma (OSCC) at an early stage when they are most treatable. The authors conducted a systematic review to assess the effectiveness of the COE in predicting histologic diagnosis of dysplasia or OSCC. METHODS The authors conducted automated searches of PubMed, Web of Knowledge and the Cochrane Library from 1966 through 2010 for randomized controlled trials and observational studies that included the terms "oral mucosal lesion screening" and "oral lesions." They determined the quality (sensitivity, specificity, positive predictive value, negative predictive value and diagnostic odds ratio) of selected studies by using the Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS The overall diagnostic odds ratio was 6.1 (95 percent confidence interval, 2.1-17.6); therefore, the COE was considered to have poor overall performance as a diagnostic method for predicting dysplasia and OSCC. CLINICAL IMPLICATIONS On the basis of the available literature, the authors determined that a COE of mucosal lesions generally is not predictive of histologic diagnosis. The fact that OSCCs often are diagnosed at an advanced stage of disease indicates the need for improving the COE and for developing adjuncts to help detect and diagnose oral mucosal lesions.
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Damek-Poprawa M, Both S, Wright AC, Maity A, Akintoye SO. Onset of mandible and tibia osteoradionecrosis: a comparative pilot study in the rat. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 115:201-11. [PMID: 23254371 DOI: 10.1016/j.oooo.2012.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 09/04/2012] [Accepted: 09/08/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Osteoradionecrosis (ORN) is common in the jaws after radiotherapy. We hypothesized that the mandible is more susceptible to ORN than the tibia, based on site disparity in hypoxic, hypocellular, and hypovascular tissue breakdown. STUDY DESIGN Twelve rats received 50 Gy irradiation to mandible or tibia; 4 of the rats further received minor surgical trauma to the irradiated sites. Structural and cellular skeletal changes were assessed with computerized tomography, histology, and immunostaining. RESULTS Mandible developed ORN with 70% mean bone loss 10 weeks after irradiation (P < .05), whereas tibia was structurally and radiologically intact 20 weeks after irradiation. Hypocellularity, hypoxia, and oxidative stress were higher in irradiated mandible (P < .001) than tibia (P < .01) but vascular damage was similar at both skeletal sites. Combined effects of radiation and minor trauma promoted mandibular alveolar bone loss and tibial fracture. CONCLUSIONS ORN has a more rapid onset in mandible than in tibia in the rat.
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Affiliation(s)
- Monika Damek-Poprawa
- Department of Microbiology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Frydrych AM, Slack-Smith LM, Park JH, Smith AC. Expertise regarding dental management of oral cancer patients receiving radiation therapy among Western Australian dentists. Open Dent J 2012; 6:197-207. [PMID: 23284592 PMCID: PMC3529396 DOI: 10.2174/1874210601206010197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 09/09/2012] [Accepted: 10/12/2012] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Dental care forms an important part of the multidisciplinary management of oral cancer patients. The aim of this study was to examine actual and self-perceived knowledge and clinical expertise regarding dental management of oral cancer patients receiving radiation therapy among Western Australian general dentists. MATERIALS AND METHODS An invitation to participate in a web-based questionnaire was emailed to 1095 dentists registered with the Australian Dental Association (ADA), WA branch. To assess dentists' knowledge and expertise, actual and perceived knowledge was investigated. Information regarding type of practice, practice location, year of graduation and number of oral cancer patients treated in the preceding 12 months was also obtained. RESULTS One hundred and ninety one dentists responded to the survey. General dentists who took part in the study appeared to possess some knowledge regarding dental management of oral cancer patients treated with radiation therapy. The majority of responders however identified deficiencies in their knowledge and willingness to participate in continuing education programs. CONCLUSION In view of the rising incidence of oral cancer in Western Australia, efforts should be made to provide more clinically relevant training to dentists in this area.
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Affiliation(s)
- AM Frydrych
- School of Dentistry, The University of Western Australia, Perth, Western Australia
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Bueno AC, Ferreira RC, Barbosa FI, Jham BC, Magalhães CS, Moreira AN. Periodontal care in patients undergoing radiotherapy for head and neck cancer. Support Care Cancer 2012; 21:969-75. [PMID: 23052920 DOI: 10.1007/s00520-012-1614-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 09/19/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to evaluate periodontal changes after periodontal treatment and control in patients with malignant tumors of the upper aerodigestive tract who were submitted to radiotherapy with or without chemotherapy. METHODS We included all patients attending the Oncology Clinic of the Federal University of Minas Gerais, School of Dentistry. Clinical periodontal parameters obtained by a single calibrated examiner were evaluated at baseline, 10 days after radiotherapy, and 180 days after radiotherapy. Patients were grouped into healthy or periodontally diseased individuals. All patients received oral hygiene instructions, and the diseased patients received periodontal therapy at baseline. Comparisons between the groups were performed via the McNemar and Wilcoxon tests using SPSS v. 17.0. RESULTS A total of 28 patients were examined at baseline, of which 27 were examined 10 days after radiotherapy and 25 were examined 180 days after radiotherapy. The prevalence of periodontal disease at baseline was 67.9 % and did not decrease over time (p = 1.0). There was a significant reduction in probing depth (PD), plaque index (PI), and bleeding on probing between baseline and follow-up, which was not observed in the attachment level (AL). CONCLUSIONS Periodontal therapy was effective in reducing PI and improving periodontal status, as evidenced by the decreases in PD and the maintenance of AL.
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Affiliation(s)
- Audrey Cristina Bueno
- Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil.
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25
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Deboni ALDS, Giordani AJ, Lopes NNF, Dias RS, Segreto RA, Jensen SB, Segreto HRC. Long-term oral effects in patients treated with radiochemotherapy for head and neck cancer. Support Care Cancer 2012; 20:2903-11. [DOI: 10.1007/s00520-012-1418-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 02/14/2012] [Indexed: 11/24/2022]
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Platelet-rich plasma in bone repair of irradiated tibiae of Wistar rats. Acta Cir Bras 2011; 25:257-63. [PMID: 20498938 DOI: 10.1590/s0102-86502010000300007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 03/15/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the influence of PRP addition on bone repair of circular defects created in irradiated tibiae of rats by histometric analysis. METHODS Sixty male Wistar rats had the right tibiae irradiated with 30 Gy. After 30 days monocortical defects were created and platelet-rich plasma was applied in 30 rats. In the control group defects were created but not filled. The animals were desanguinated after 4, 7, 14, 21, 56 and 84 days and the tibiae removed for histological processing. RESULTS There was a tendency in the PRP group to increased bone neoformation from 14-days to 84-days; in the control group increased bone neoformation was not seen after 21 days or later. CONCLUSION The addition of platelet-rich plasma had a beneficial effect in the initial cellular regeneration period and enhanced bone formation in later periods when compared to control.
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Palaniyandi S, Odaka Y, Green W, Abreo F, Caldito G, Benedetti AD, Sunavala-Dossabhoy G. Adenoviral delivery of Tousled kinase for the protection of salivary glands against ionizing radiation damage. Gene Ther 2010; 18:275-82. [DOI: 10.1038/gt.2010.142] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Lalla RV, Latortue MC, Hong CH, Ariyawardana A, D'Amato-Palumbo S, Fischer DJ, Martof A, Nicolatou-Galitis O, Patton LL, Elting LS, Spijkervet FKL, Brennan MT. A systematic review of oral fungal infections in patients receiving cancer therapy. Support Care Cancer 2010; 18:985-92. [PMID: 20449755 DOI: 10.1007/s00520-010-0892-z] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 04/22/2010] [Indexed: 01/12/2023]
Abstract
PURPOSE The aims of this systematic review were to determine, in patients receiving cancer therapy, the prevalence of clinical oral fungal infection and fungal colonization, to determine the impact on quality of life and cost of care, and to review current management strategies for oral fungal infections. METHODS Thirty-nine articles that met the inclusion/exclusion criteria were independently reviewed by two calibrated reviewers, each using a standard form. Information was extracted on a number of variables, including study design, study population, sample size, interventions, blinding, outcome measures, methods, results, and conclusions for each article. Areas of discrepancy between the two reviews were resolved by consensus. Studies were weighted as to the quality of the study design, and recommendations were based on the relative strength of each paper. Statistical analyses were performed to determine the weighted prevalence of clinical oral fungal infection and fungal colonization. RESULTS For all cancer treatments, the weighted prevalence of clinical oral fungal infection was found to be 7.5% pre-treatment, 39.1% during treatment, and 32.6% after the end of cancer therapy. Head and neck radiotherapy and chemotherapy were each independently associated with a significantly increased risk for oral fungal infection. For all cancer treatments, the prevalence of oral colonization with fungal organisms was 48.2% before treatment, 72.2% during treatment, and 70.1% after treatment. The prophylactic use of fluconazole during cancer therapy resulted in a prevalence of clinical fungal infection of 1.9%. No information specific to oral fungal infections was found on quality of life or cost of care. CONCLUSIONS There is an increased risk of clinically significant oral fungal infection during cancer therapy. Systemic antifungals are effective in the prevention of clinical oral fungal infection in patients receiving cancer therapy. Currently available topical antifungal agents are less efficacious, suggesting a need for better topical agents.
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Affiliation(s)
- Rajesh V Lalla
- University of Connecticut Health Center, Farmington, CT 06030, USA.
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Wranicz P, Herlofson BB, Evensen JF, Kongsgaard UE. Prevention and treatment of trismus in head and neck cancer: A case report and a systematic review of the literature. Scand J Pain 2010; 1:84-88. [DOI: 10.1016/j.sjpain.2010.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 01/20/2010] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Trismus, or limited mouth opening, is a well-known complication of head and neck cancer and its treatment. It may be caused by tumour infiltration into the masticatory muscles or by treatment like surgery and radiotherapy. A limited mouth opening may have a negative effect on nutrition, phonation, dental hygiene and treatment, and quality of life. The severity of this complication depends on the location of the tumour, the type of reconstruction, the total radiation dose, fractionation, and treatment techniques. If there is no intervention, these changes may be progressive and persist for life. There are no specific treatments for trismus. Current strategies emphasize prevention and, in instances of existing trismus, collaboration between health care professionals to establish pain control, prevent the progression of trismus, and restore function. The prevalence of trismus in head and neck cancer patients ranges from 5% to 38%. Despite numerous studies, reliable data on the aetiology of trismus and appropriate treatment for it are scarce.
Case report
We describe a patient with squamous cell carcinoma of the oropharynx who developed trismus after surgery and radiotherapy. A multidisciplinary treatment strategy including analgesics, regional blocks, hyperbaric oxygenation therapy, external dynamic bite opener and physiotherapy, increased the mouth opening from 5 mm to 22 mm, however, the patient still suffered from xerostomia and had problems with intake of solid food.
Material and methods
A systematic literature search (starting January 1., 1980, and ending June 1., 2009) was performed to identify evidence-based interventions for the treatment of trismus in head and neck cancer patients. A total of 244 articles were identified from the databases. Of these, eight were excluded because of the absence of an English abstract and 214 were excluded because they were of marginal relevance to the inclusion criteria. The remaining 22 articles were evaluated independently by two experts using the Scottish Inter-collegiate Guidelines Network criteria for quality and evidence.
Results
There were few studies of good methodological quality on this topic. Two systematic reviews and two RCTs were identified. The other reports involved cohorts, case series, and expert opinions.
Discussion
Evidence in the form of clinical studies on therapeutic interventions is scarce. Numerous pharmacological treatment modalities have been described, but few are supported by the results of comparative trials involving control groups. Few studies have documented therapeutic effects for longer than a year. Better evidence was found for non-pharmacological methods, especially for physical therapy with passive and active stretching exercises, an important first-line strategy. The interincisal distance criterion for trismus varies between authors from 15 to 40 mm, which renders comparison between studies difficult. The absence of a standardized assessment protocol may also have contributed to variation between studies. An interincisal distance of 35 mm has been proposed as a definition of trismus. Explicit and precise treatment algorithms could not be established based on the available literature. However, a coordinated multidisciplinary approach in order to estimate and understand patient dysfunction is recommended; a systematic treatment plan should result in good symptom control and patient care. Prevention of trismus is more desirable than treatment for trismus.
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Affiliation(s)
- Piotr Wranicz
- Division of Emergency Medicine , Oslo University Hospital , Oslo , Norway
- The Norwegian Radium Hospital , Montebello, 0310 Oslo , Norway
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine , Institute of Clinical Dentistry , PO Box 1109 Blindern, 0317 Oslo , Norway
- Cancer Clinic , The Norwegian Radium Hospital , Rikshospitalet, Montebello, 0310 Oslo , Norway
- Faculty of Dentistry , University of Oslo , Oslo , Norway
| | - Jan F. Evensen
- Cancer Clinic , Oslo University Hospital, The Norwegian Radium Hospital , Montebello, 0310 Oslo , Norway
| | - Ulf E. Kongsgaard
- Division of Emergency Medicine , Oslo University Hospital , Oslo , Norway
- The Norwegian Radium Hospital , Montebello, 0310 Oslo , Norway
- Medical Faculty , University of Oslo , Oslo , Norway
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Werner MU. Trismus-An important issue in pain and palliative care. Scand J Pain 2010; 1:82-83. [PMID: 29913941 DOI: 10.1016/j.sjpain.2010.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Mads U Werner
- Multidisciplinary Pain Center 7612, Neuroscience Center, Rigshospitalet, Copenhagen University Hospitals, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
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Danesi CC, Bellagamba BC, Dihl RR, de Andrade HHR, Cunha KS, Spanó MA, Reguly ML, Lehmann M. Mutagenic evaluation of combined paclitaxel and cisplatin treatment in somatic cells of Drosophila melanogaster. Mutat Res 2010; 696:139-143. [PMID: 20083227 DOI: 10.1016/j.mrgentox.2010.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 11/09/2009] [Accepted: 01/11/2010] [Indexed: 05/28/2023]
Abstract
Recent studies have added paclitaxel (PAC) to traditional cisplatin (CIS) regimen to treat squamous cell carcinoma of the head and neck. The target of these antineoplastic agents is nuclear DNA for CIS and microtubules for PAC, although it is not restricted to malignant cells. In this study, the genotoxicity of the combined treatment of PAC and CIS was investigated using the standard version of the wing Somatic Mutation and Recombination Test (SMART) in Drosophila melanogaster. Quantitative and qualitative genotoxic effects of these compounds were estimated by comparing wing spot frequencies in marker-heterozygous to balancer-heterozygous flies. Two different concentrations of PAC (0.0025 and 0.005mM) and CIS (0.025 and 0.05mM) as well as combinations of them were employed. The results demonstrated that the spindle poison PAC alone was not genotoxic in this test system, while CIS was able to induce a high incidence of DNA damage in both genotypes, mainly related to somatic recombination. The data obtained for the combined treatments showed that its genotoxicity varied with the concentrations used. In small concentrations the number of total spots induced by combination was reduced in relation to CIS 0.025mM just for marker-heterozygous flies, showing that somatic recombination was the prevalent event involved. At higher concentrations the combined treatment showed significant reductions in the frequencies of large single spots, for both genotypes, and twin spots for marker-heterozygous flies, but did not significantly reduce the total spots frequency in either genotype. The data suggest that aneugenic activity of PAC could be responsible for the reduction in the genotoxicity of CIS.
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Affiliation(s)
- Cristiane Cademartori Danesi
- Programa de Pós-Graduação em Genética e Toxicologia Aplicada, Universidade Luterana do Brasil, Canoas, RS, Brazil
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Abstract
Practitioners of oral medicine frequently encounter patients with complaints of taste disturbance. While some such complaints represent pathological processes specific to the gustatory system, per se, this is rarely the case. Unless taste-bud mediated qualities such as sweet, sour, bitter, salty, umami, chalky, or metallic are involved, 'taste' dysfunction inevitably reflects damage to the sense of smell. Such 'taste' sensations as chicken, chocolate, coffee, raspberry, steak sauce, pizza, and hamburger are dependent upon stimulation of the olfactory receptors via the nasopharynx during deglutition. In this paper, we briefly review the anatomy, physiology, and pathophysiology of the olfactory system, along with means for clinically assessing its function. The prevalence, etiology, and nature of olfactory disorders commonly encountered in the dental clinic are addressed, along with approaches to therapy and patient management.
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Affiliation(s)
- S M Bromley
- Department of Neurology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden, NJ, USA
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