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Use of Kinesiography to Assess Mandibular Function Following Segmental Resection and Microvascular Reconstruction. J Craniofac Surg 2020; 31:2256-2259. [PMID: 33136866 DOI: 10.1097/scs.0000000000006774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mandibular reconstruction has attained adequate morphological outcomes. However, some patients encounter difficulties in oral function and limited mandibular movements. An objective: evaluation has seldom featured actual kinetic measurements after mandibular reconstruction.Thirty patients who underwent mandibular reconstruction using bony free flap were enrolled in the study. Twenty-two patients were recruited after surgery and compared to a control group of 8 healthy subjects; 8 patients underwent both pre and postoperative evaluations. For each patient, a kinesiographic scan was obtained, recording maximum mouth opening, maximal laterality, and maximal protrusion.All postoperative kinesiographic evaluations were performed at least 6 months after surgery to ensure complete healing. In the first group of 22 patients, all measured movements were less than those of healthy controls, in particular maximum mouth opening. In the second study group (pre and postoperative evaluation), the postsurgical values did not achieve the control ones, but were no less than the preoperative values, granting adequate functional outcomes.The kinesiograph appears useful for objectively recording the functional outcomes in patients who have undergone mandibular reconstruction. The postoperative jaw movements were acceptable, ensuring a sufficient functional recovery.
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Assessment of Quality of Life of Free Anterolateral Thigh Flap for Reconstruction of Tissue Defects of Total or Near-Total Glossectomy. JOURNAL OF ONCOLOGY 2020; 2020:2920418. [PMID: 33101411 PMCID: PMC7569442 DOI: 10.1155/2020/2920418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/26/2019] [Accepted: 01/28/2020] [Indexed: 11/17/2022]
Abstract
Background The aim of this study was to evaluate quality of life of free anterolateral thigh flap (ALTFF) for reconstruction of tissue defects of total or near-total glossectomy. Methods Quality of life was assessed by means of the University of Washington Quality of Life (UW-QOL) and the 14-item Oral Health Impact Profile (OHIP-14), after 12 months postoperatively. Results 65 of 79 questionnaires were returned (82.27%). In the UW-QOL, the best-scoring domain was “shoulder,” whereas the lowest scores were for “chewing” and “pain.” In the OHIP-14, the lowest-scoring domain was “handicap,” followed by “Social disability” and “Psychological disability.” Conclusion Free anterolateral thigh perforator flaps for reconstruction of total or near-total glossectomy defects after cancer resection would have significantly influenced the patients' oral functions and quality of life.
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de Groot RJ, Merkx MAW, Hamann MNS, Brand HS, de Haan AFJ, Rosenberg AJWP, Speksnijder CM. Tongue function and its influence on masticatory performance in patients treated for oral cancer: a five-year prospective study. Support Care Cancer 2019; 28:1491-1501. [PMID: 31273502 PMCID: PMC6989568 DOI: 10.1007/s00520-019-04913-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/31/2019] [Indexed: 12/20/2022]
Abstract
Purpose The purpose of this study was to observe the impact of oral oncological treatment, including the recovery of several tongue functions (force, mobility, and sensory functions), and to determine the influence of these functions on masticatory performance. Materials and methods Masticatory performance and tongue force, mobility, and sensory functions were determined in 123 patients with oral cavity cancer. The assessments were performed 4 weeks before treatment and 4 to 6 weeks, 6 months, 1 year, and 5 years after treatment. Generalized estimation equations and mixed model analyses were performed, correcting for previously identified factors in the same population. Results A significant deterioration in tongue mobility and sensory function was observed in patients with mandible and tongue and/or floor-of-mouth tumors. Better tongue force and sensory function (thermal and tactile) positively influenced masticatory performance, and this effect was stronger where fewer occlusal units were present. The effect of both the tongue force and maximum bite force was weaker in dentate patients in comparison with patients with full dentures. A web-based application was developed to enable readers to explore our results and provide insight into the coherence between the found factors in the mixed model. Conclusions Tongue function deteriorates after oral oncological treatment, without statistically significant recovery. Adequate bite and tongue forces are especially important for patients with a poor prosthetic state. Patients with sensory tongue function deficits especially benefit from the presence of more occluding pairs.
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Affiliation(s)
- Reilly J de Groot
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Merel N S Hamann
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Henk S Brand
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anton F J de Haan
- Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands.
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands.
- University Medical Center Utrecht, Cancer Center, Department of Head and Neck Surgical Oncology, Utrecht University, Utrecht, The Netherlands.
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Watters AL, Cope S, Keller MN, Padilla M, Enciso R. Prevalence of trismus in patients with head and neck cancer: A systematic review with meta‐analysis. Head Neck 2019; 41:3408-3421. [DOI: 10.1002/hed.25836] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/15/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Amber L. Watters
- Master of Science Program in Orofacial Pain and Oral MedicineHerman Ostrow School of Dentistry of University of Southern California Los Angeles California
- Oral OncologyProvidence Cancer Institute, Robert W. Franz Cancer Center Portland Oregon
| | - Shane Cope
- Master of Science Program in Orofacial Pain and Oral MedicineHerman Ostrow School of Dentistry of University of Southern California Los Angeles California
| | - Meir N. Keller
- Master of Science Program in Orofacial Pain and Oral MedicineHerman Ostrow School of Dentistry of University of Southern California Los Angeles California
| | - Mariela Padilla
- Division of Periodontology, Diagnostic Sciences & Dental HygieneHerman Ostrow School of Dentistry of University of Southern California Los Angeles California
| | - Reyes Enciso
- Division of Dental Public Health and Pediatric DentistryHerman Ostrow School of Dentistry of University of Southern California Los Angeles CA
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Petrovic I, Baser R, Blackwell T, McCarthy C, Ganly I, Patel S, Cordeiro P, Shah J. Long-term functional and esthetic outcomes after fibula free flap reconstruction of the mandible. Head Neck 2019; 41:2123-2132. [PMID: 30761650 DOI: 10.1002/hed.25666] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/25/2018] [Accepted: 01/07/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The goal of this study is to report functional and esthetic outcomes, after fibula free flap (FFF) reconstruction of the mandible for oral cancer, assessed by physicians, nonclinicians, and patients. METHODS Twenty-five long-term survivors from oral cancer after FFF reconstruction were recalled for head and neck examination by surgeons, for photographs and patient-reported outcomes, using EORTC, QLQ-C30, H&N35, and FACE-Q questionnaires. RESULTS Physicians reported 64% restoration of functionality compared to normal. Patients reported high scores on QLQ-C30 but lower scores on H&N35. Esthetic scores were reported higher by clinicians than nonclinicians. The decline in function and appearance was attributed to loss of lower dentition, trismus, malocclusion, xerostomia, and tissue atrophy. CONCLUSION To minimize the decline in function and appearance, immediate dental implants in FFF, better reconstruction of the temporomandibular joint, newer methods of radiotherapy to minimize xerostomia and oral exercises to prevent trismus should be considered.
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Affiliation(s)
- Ivana Petrovic
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raymond Baser
- Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Timothy Blackwell
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Colleen McCarthy
- Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Snehal Patel
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter Cordeiro
- Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jatin Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Memorial Sloan Kettering Cancer Center, and Weil Cornell Medical College, New York.,Department of Oncology and Reconstructive Surgery, I.M. Sechenov First Moscow State Medical University, Moscow
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Romer CAE, Broglie Daeppen MA, Mueller M, Huber GF, Guesewell S, Stoeckli SJ. Long-term speech and swallowing function after primary resection and sentinel node biopsy for early oral squamous cell carcinoma. Oral Oncol 2019; 89:127-132. [PMID: 30732950 DOI: 10.1016/j.oraloncology.2018.12.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 12/16/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Analysis of long-term speech and swallowing function and subjective quality of life (QOL) after primary resection and sentinel node biopsy (SNB) in patients with early stage (cT1/T2) oral squamous cell carcinomas (OSCC). MATERIAL AND METHODS Eighty-one consecutive patients treated primarily by transoral resection without flap reconstruction and SNB for a cT1/T2 OSCC were included. Completion neck dissection (CND) was indicated in case of occult disease in the sentinel nodes. Adjuvant radiation (aRT) was administered according to the ultimate lymph node status. All patients showed no evidence of disease at time of analysis. Speech and swallowing function were assessed using standardized clinical examinations (11-item, articulation test) and validated questionnaires on subjective QOL (MDADI, FIGS). Median follow-up was 60 months (range 13-159 months) after initial treatment. RESULTS In all assessments for speech and swallowing, the entire study cohort achieved very high scores, with mean values located in the highest 10% of the scales. Neither tumor size nor site, age, pN-category, CND, and aRT had significant impact on functional outcomes and subjective QOL with the exception of lower scores in the global and physical scores of MDADI after CND or aRT, and articulation in the population over 60 years of age. CONCLUSION Transoral resection without reconstruction and SNB for early OSCC achieves excellent outcome with regard to speech, swallowing and subjective QOL.
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Affiliation(s)
- C A E Romer
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Switzerland.
| | - M A Broglie Daeppen
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Switzerland; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Switzerland
| | - M Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Switzerland
| | - G F Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Switzerland; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Switzerland
| | - S Guesewell
- Clinical Trials Unit, Kantonsspital St. Gallen, Switzerland
| | - S J Stoeckli
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Switzerland
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Bolzoni A, Mapelli A, Baj A, Sidequersky FV, Giannì AB, Sforza C. Evaluation of three-dimensional mandibular movements after reconstruction with free fibula flap. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 35:371-8. [PMID: 26900241 PMCID: PMC4755051 DOI: 10.14639/0392-100x-504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Seven patients who underwent mandibular reconstruction with a fibula free flap (one on the midline, six on either right or left side) and were rehabilitated with implant supported prostheses, performed free mandibular border movements (maximal mouth opening and closing, right and left lateral excursions, protrusion) that were recorded by a non-invasive motion analyser. Temporomandibular joint (TMJ) kinematic parameters were compared to those calculated in healthy control subjects using z-scores. Maximum mouth opening was reduced in all patients, with z-scores ranging from -2.742 to -0.106, and performed with a reduced sagittal plane mandibular rotation. Interincisal point forward movement during protrusion was reduced in all but one patient. Lateral mandibular movements (displacement of the interincisal point) and bilateral condylar movements during mouth opening were very variable and sometimes asymmetrical. Mandibular rotation was also variable, with z-scores ranging from -1.265 to 1.388. Together with mandibular range of motion, we investigated biomechanical characteristics of TMJ motion that can provide further information about the joint without submitting the patient to harmful procedures, and that can be followed-up during healing. The investigation indicates those areas that need to be given special attention in preoperative planning, patient information and rehabilitation.
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Affiliation(s)
- A Bolzoni
- Maxillofacial and Odontostomatology Unit, IRCSS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Department of Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Italy
| | - A Mapelli
- Functional Anatomy Research Center (FARC), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy;; Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine, Ribeirão Preto, University of São Paulo, Brazil
| | - A Baj
- Maxillofacial and Odontostomatology Unit, IRCSS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Department of Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Italy
| | - F V Sidequersky
- Functional Anatomy Research Center (FARC), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy;; Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine, Ribeirão Preto, University of São Paulo, Brazil
| | - A B Giannì
- Maxillofacial and Odontostomatology Unit, IRCSS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Department of Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Italy
| | - C Sforza
- Functional Anatomy Research Center (FARC), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy
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Kouketsu A, Nogami S, Yamada-Fujiwara M, Nagai H, Yamauchi K, Mori S, Miyashita H, Kawai T, Matsui A, Kataoka Y, Satomi N, Ezoe Y, Abe S, Takeda Y, Tone T, Hirayama B, Kurobane T, Tashiro K, Yanagisawa Y, Takahashi T. Clinical evaluations of complete autologous fibrin glue, produced by the CryoSeal ® FS system, and polyglycolic acid sheets as wound coverings after oral surgery. J Craniomaxillofac Surg 2017; 45:1458-1463. [DOI: 10.1016/j.jcms.2017.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 05/11/2017] [Accepted: 06/02/2017] [Indexed: 11/15/2022] Open
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Trismus following different treatment modalities for head and neck cancer: a systematic review of subjective measures. Eur Arch Otorhinolaryngol 2017; 274:2695-2707. [PMID: 28343337 PMCID: PMC5486547 DOI: 10.1007/s00405-017-4519-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/21/2017] [Indexed: 11/12/2022]
Abstract
The aim of this review was to compare systematically the subjective measure of trismus between different interventions to treat head and neck cancer, particularly those of the oropharynx. Using The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Guidelines, Six databases were searched for the text using various terms which include “oropharyngeal/head and neck cancer”, “trismus/mouth opening” and the various treatment modalities. Included in the review were clinical studies (> or =10 patients). Three observers independently assessed the papers identified. Among the six studies reviewed, five showed a significantly worst outcome with regard to the quality-of-life questionnaire scores for a radiotherapy or surgery and radiotherapy (RT) ± chemotherapy or chemoradiotherapy when compared to surgery alone. Only one study showed no significant difference between surgery alone and other treatment modalities. Subjective quality-of-life measures are a concurrent part of modern surgical practice. Although subjective measures were utilised to measure post operative trismus successfully, there was no consensus as to which treatment modality had overall better outcomes, with conflicting studies in keeping with the current debate in this field. Larger and higher quality studies are needed to compare all three treatment modalities.
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Agarwal P, Shiva Kumar HR, Rai KK. Trismus in oral cancer patients undergoing surgery and radiotherapy. J Oral Biol Craniofac Res 2016; 6:S9-S13. [PMID: 27900243 DOI: 10.1016/j.jobcr.2016.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 10/10/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the incidence of trismus before and after surgery and subsequent radiotherapy for patients of oral cancer and to determine the risk factors for the same. METHODS 30 patients diagnosed with oral cancer were included. Maximum mouth opening was measured for each patient as the inter incisal distance and was measured on 4 occasions - preoperatively at the time of diagnosis, post-operatively at discharge from the hospital, post-radiotherapy and at 6 months follow-up. The site of cancer, staging and grading of the malignancy, the surgical treatment performed, method of reconstruction, details of radiotherapy and compliance to physiotherapy were recorded, to evaluate the risk factors for developing trismus. RESULTS Trismus was observed in 53.3% patients at the time of diagnosis which increased significantly post-surgery (86.7%) and post-radiotherapy (85.7%) and gradually decreased (65.4%) at 6 months. The use of flaps for reconstruction, delay in radiotherapy post-surgery and non-compliance of patients to physiotherapy were the risk factors for developing trismus, showing statistical significance (p < 0.05). CONCLUSION Trismus is a significant complication of oral malignancies or its surgical and radiotherapy treatment, or both. Consideration must be given to its early diagnosis, to help in timely intervention and planning of preventive strategies.
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Affiliation(s)
- Padmanidhi Agarwal
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, India
| | - H R Shiva Kumar
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, India
| | - Kirthi Kumar Rai
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, India
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Kouketsu A, Nogami S, Fujiwara M, Mori S, Yamauchi K, Hashimoto W, Miyashita H, Kurihara J, Kawai T, Higuchi K, Takahashi T. Clinical evaluations of autologous fibrin glue and polyglycolic acid sheets as oral surgical wound coverings after partial glossectomy. J Craniomaxillofac Surg 2016; 44:964-8. [PMID: 27341770 DOI: 10.1016/j.jcms.2016.05.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/18/2016] [Accepted: 05/31/2016] [Indexed: 11/24/2022] Open
Abstract
Polyglycolic acid (PGA) sheets and commercial fibrin glue are commonly used to cover open wound surfaces in oral surgery. Compared to commercial fibrin glue composed of pooled allogeneic blood, autologous fibrin glue is less expensive and poses lower risks of viral infection and allergic reaction. Here, we evaluated postoperative pain, scar contracture, ingestion, tongue dyskinesia, and postoperative bleeding in 24 patients who underwent partial glossectomy plus the application of a PGA sheet and an autologous fibrin glue covering (autologous group) versus 11 patients in whom a PGA sheet and commercial fibrin glue were used (allogeneic group). The evaluated clinical measures were nearly identical in both groups. Remarkable wound surface granulation was recognized in two cases in the autologous group. No complications were observed in either group, including viral infection or allergic reaction. Abnormal postoperative bleeding in the wound region was observed in one case in the allogeneic group. Coagulation and adhesion of the autologous fibrin glue were equivalent to those of conventional therapy with a PGA sheet and commercial fibrin glue. Thus, our results show that covering wounds with autologous fibrin glue and PGA sheets may help avoid the risks of viral infection and allergic reaction in partial glossectomy cases.
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Affiliation(s)
- Atsumu Kouketsu
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
| | - Shinnosuke Nogami
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Minami Fujiwara
- Division of Blood Transfusion and Cell Processing, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Shiro Mori
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Wataru Hashimoto
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Hitoshi Miyashita
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Jun Kurihara
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Tadashi Kawai
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Keisuke Higuchi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
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Psychological Distress and Health-Related Quality of Life among Head and Neck Cancer Patients during the First Year after Treatment. TUMORI JOURNAL 2015; 102:96-102. [DOI: 10.5301/tj.5000448] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 11/20/2022]
Abstract
Purpose Patients treated for head and neck cancer present some of the most significant posttreatment morbidity of any group of patients with cancer. Our aim is to describe quality of life and psychological distress after different treatments among head and neck cancer patients during the first year after treatment. Methods A total of 86 patients treated for head and neck cancer were evaluated within 1 year of the end of treatment by means of the Distress Thermometer (DT) and EORTC C30 and H&N35 questionnaires. Type of treatment was classified into 3 groups: surgery, chemo-/radiotherapy, and combined treatment. Results Forty-one percent of patients showed a high level of distress (DT >5). Distress was higher in patients with a tracheotomy or with previous cancer in another district. Quality of life was homogeneous across treatment types after adjustment for stage and time since end of treatment, except for higher levels of suffering related to sensory problems, social eating, and dry mouth among patients treated with combined therapy. Conclusions The DT and EORTC questionnaires proved to be effective and easy tools to monitor distress and quality of life in patients with head and neck cancer. Monitoring the quality of life perceived by each patient during his/her course of treatment could be useful in planning the rehabilitation process while performing follow-up visits.
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Liu WC, Yang KC. One-stage through-and-through cheek, lips, and oral commissure reconstruction using a double-paddle peroneal chimeric flap: An innovative method. Head Neck 2014; 37:662-9. [DOI: 10.1002/hed.23658] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/25/2013] [Accepted: 03/01/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Wen-Chung Liu
- Division of Plastic Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- College of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Kuo-Chung Yang
- Division of Plastic Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- College of Medicine; National Yang-Ming University; Taipei Taiwan
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14
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Speech and swallowing following tongue cancer surgery and free flap reconstruction – A systematic review. Oral Oncol 2013; 49:507-24. [DOI: 10.1016/j.oraloncology.2013.03.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 02/04/2013] [Accepted: 03/04/2013] [Indexed: 11/20/2022]
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López-Jornet P, Camacho-Alonso F, López-Tortosa J, Palazon Tovar T, Rodríguez-Gonzales MA. Assessing quality of life in patients with head and neck cancer in Spain by means of EORTC QLQ-C30 and QLQ-H&N35. J Craniomaxillofac Surg 2012; 40:614-20. [DOI: 10.1016/j.jcms.2012.01.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 01/30/2012] [Accepted: 01/30/2012] [Indexed: 10/28/2022] Open
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Schuster M, Stelzle F. Outcome measurements after oral cancer treatment: speech and speech-related aspects--an overview. Oral Maxillofac Surg 2012; 16:291-8. [PMID: 22864645 DOI: 10.1007/s10006-012-0340-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 07/16/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Oral cancer and its surgical treatment impair speech quality by an alteration of the vocal tract. Local size and stage of the tumour as well as surgical and adjuvant treatment modalities have an impact on the functional outcome of patients' speech rehabilitation. It was the aim of this overview to specifiy speech and speech-related aspects as well as to delineate measurement methods of speech outcome in patients with oral cancer by a review of the literature. METHODS The review is based on a Medline Search on "speech", "cancer", "oral cancer", "malignoma mouth", "intelligibility", "formant", "ultrasound". DISCUSSION In particular, speech intelligibility is inevitable for the social interaction of patients which is highly correlated with the patient's quality of life. However, speech outcome measurement shows a variety of methods without an international standardisation. Additionally, several co-aspects of speech production have to be considered: tongue mobility, voice production, velopharyngeal closure and neural coordination are important influencing factors. Speech assessment is traditionally performed by perceptual methods on a subjective or semi-subjective base. More objective, technical-based methods of speech evaluation are in development and under research. PURPOSE It was the aim of this overview to specify speech and speech-related aspects as well as to delineate measurement methods of speech outcome in patients with oral cancer by a review of the current literature.
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Affiliation(s)
- M Schuster
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Chang KP, Lai CS, Hsieh TY, Wu YC, Chang CH. Two-year quality of life after free flap reconstruction in tumor-site discrepancy among Taiwanese with moderately advanced oral squamous cell carcinoma. World J Surg Oncol 2012; 10:145. [PMID: 22789070 PMCID: PMC3412696 DOI: 10.1186/1477-7819-10-145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 07/13/2012] [Indexed: 11/20/2022] Open
Abstract
Background This study describes 2-year impact on quality of life (QOL) in relation to the anatomical discrepancy among T4a oral cancer patients after free flap reconstruction in Taiwan. Methods Thirty-two patients who underwent tumor ablation with simultaneous microvascular free flap transfer at 2-year follow-up were recruited. They were divided into six subgroups, according to the resected area, consisting of: (1) buccal/retromolar trigone; (2) cheek; (3) commissure; (4) lip; (5) mandible; and (6) tongue. Functional disturbances and daily activity were analyzed using the Version-1 UW QOL Questionnaire with one more specific category: ‘Drooling’. Kruskal-Wallis rank sums analysis was used to test differences in average QOL scores between these subgroups. Post-hoc analysis was applied to assess influence of dominant categories between subgroups. Results The category ‘Pain’ revealed the highest average score and reached significant statistical difference (P = 0.019) among all the categories, however, the category ‘Employment’ averaged the lowest score. Regarding ‘Pain’, there existed a statistical significance (P = 0.0032) between the commissure- and cheek-involved groups, which described the former showed poorer pain quality of life. Conclusions The commissure-involved group had the lowest average score, which might imply the worst QOL in our study, especially for the categories ‘Pain’ and ‘Drooling’. This present study of T4a patients was the first carried out in Taiwan implementing the QOL questionnaire, and its results may serve for future reference.
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Affiliation(s)
- Kao-Ping Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Functional outcome after different oncological interventions in head and neck cancer patients. J Cancer Res Clin Oncol 2011; 138:371-6. [DOI: 10.1007/s00432-011-1106-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 11/21/2011] [Indexed: 10/15/2022]
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Speksnijder CM, van der Bilt A, van der Glas HW, Koole R, Merkx MAW. Tongue function in patients treated for malignancies in tongue and/or floor of mouth; a one year prospective study. Int J Oral Maxillofac Surg 2011; 40:1388-94. [PMID: 22000956 DOI: 10.1016/j.ijom.2011.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 07/07/2011] [Accepted: 09/15/2011] [Indexed: 10/16/2022]
Abstract
Progress in (reconstructive) surgery and radiotherapy tends to improve survival and reduce oral functional deficits. Despite the growing sophistication of cancer treatment, patients still report deterioration in tongue function. Sensory function, mobility, and force of the tongue were determined in 45 patients with a carcinoma of tongue and/or floor of mouth. Measurements were performed before surgery, shortly after surgery, shortly after radiotherapy, 6, and 12 months after surgery. Surgery had a negative impact on tongue sensory function and mobility. Post-surgery radiotherapy did not further deteriorate sensory function, mobility, or force of the tongue. Patients in the surgery-radiotherapy group (SRG) had significantly worse tongue sensory function and mobility than patients in the surgery group (SG), probably caused by more advanced tumour stage and more extensive reconstructions and related scar tissue. The tongue force in patients in both groups significantly increased in the first 6 months after surgery, but this increase disappeared in the next 6 months. The authors conclude that surgery had a significant negative influence on tongue function, especially in the group of patients treated with radiotherapy. No further deterioration of tongue function was observed after post-surgical radiotherapy within the first year after surgery.
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Affiliation(s)
- C M Speksnijder
- Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, The Netherlands.
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Akbulut N, Oztas B, Kursun S, Evirgen S. Delayed diagnosis of oral squamous cell carcinoma: a case series. J Med Case Rep 2011; 5:291. [PMID: 21733169 PMCID: PMC3141725 DOI: 10.1186/1752-1947-5-291] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 07/06/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In malign neoplasms, oral cancer is one of the important causes of mortality and morbidity. Squamous cell carcinoma is the most common form of oral cancers in adults and is related to risk factors such as smoking and alcohol consumption. CASE PRESENTATION In this article, we present three case reports of oral squamous cell carcinomas with delayed diagnosis. The first patient was a 52-year-old Turkish man, the second patient was a 61-year-old Turkish man and the third patient was a 60-year-old Turkish woman. All were referred to the Ankara University Faculty of Dentistry with pain, swelling and various complaints in their jaws. CONCLUSION Early diagnosis is of vital importance for the prognosis of the patients with oral squamous cell carcinomas. For this reason, dentists play a crucial role in the early detection and prevention of oral cancers.
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Affiliation(s)
- Nihat Akbulut
- Ankara University Dentistry Faculty, Department of Dentomaxillofacial Surgery, Besevler, Ankara, Turkey.
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Husein AB, Butterworth CJ, Ranka MS, Kwasnicki A, Rogers SN. A survey of general dental practitioners in the North West of England concerning the dental care of patients following head and neck radiotherapy. ACTA ACUST UNITED AC 2011; 18:59-65. [PMID: 21457625 DOI: 10.1308/135576111795162910] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIMS The aim of this survey was to investigate the views of general dental practitioners (GDPs) on their perceived roles and the barriers regarding dental care of patients following head and neck radio-therapy. METHODS From a total of 1163 GDPs on the Mersey Postgraduate Dental Deanery mailing list, 369 were selected at random. Questionnaires were sent out in February 2010 followed by reminders a month later. A study-specific questionnaire was piloted prior to the survey. RESULTS One hundred and ninety-eight of the potential 336 respondents returned valid questionnaires, a response rate of 59%. They did not respond to all questions. Of those who responded, 99/188 (53%) were either 'not at all' or 'little' happy about managing these patients and 118/183 (64%) and 100/173 (58%), respectively, perceived that complex management and the new General Dental Services (nGDS) contract introduced in 2006 were 'quite a bit' or 'very much' barriers to treatment. The majority of the respondents felt that they were 'quite a bit' or 'very much' happy to carry out routine fillings (177/195; 90%), periodontal treatment (166/195; 85%), removable dentures (161/195; 83%), crown and bridge work (123/192; 64%), and root canal therapy (114/195; 58%) but only 53/191 (28%) to perform dental extractions. Over half of the respondents felt that they had 'quite a bit' or a 'main role' in managing radiotherapy caries, xerostomia, detecting recurrence and offering smoking-cessation advice. CONCLUSION The majority of the GDPs who responded had been involved in the management of patients who had undergone radio-therapy to the head and neck. A substantial number perceived barriers to care, such as the complexity of the treatment and the nGDS contract. These findings need further investigation. Continuing professional development would be helpful to improve GDPs' confidence in dealing with this group of patients.
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Laraway DC, Rogers SN. A structured review of journal articles reporting outcomes using the University of Washington Quality of Life Scale. Br J Oral Maxillofac Surg 2011; 50:122-31. [PMID: 21239091 DOI: 10.1016/j.bjoms.2010.12.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 12/15/2010] [Indexed: 02/07/2023]
Abstract
The University of Washington Quality of Life Scale (UW-QoL) is one of the most frequently reported health-related quality of life (HR-QoL) questionnaires in head and neck cancer, and since its first publication in 1993 has been used in many different cohorts. There is a considerable amount of information to assimilate and, to date, we know of no attempt that has been made to summarise publications specific to its use in a peer review journal. The aim of this review was to systematically search published papers that report its use, identify common themes, and present a tabulated summary. Several search engines were used (PubMed, Medline, Medical-Journals.com, eMedicine), and 222 abstracts were found and hand searched. A total of 66 papers were eligible for inclusion, 21 on functional outcome, 25 on predictors of HR-QoL, 19 on development or validation of the questionnaire, and one clinical trial. The review includes a diversity of studies and a range of HR-QoL outcomes following head and neck cancer. It provides clinicians and their colleagues in multidisciplinary teams with a source of quick reference to relevant papers reporting the UW-QoL, and gives a short summary of the pertinent conclusions drawn from each paper.
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Affiliation(s)
- D C Laraway
- Liverpool Dental School, Pembroke Place, University of Liverpool, Liverpool L69 3BX, UK.
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Speksnijder CM, van der Bilt A, Abbink JH, Merkx MAW, Koole R. Mastication in patients treated for malignancies in tongue and/or floor of mouth: A 1-year prospective study. Head Neck 2010; 33:1013-20. [PMID: 20967870 DOI: 10.1002/hed.21573] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 06/01/2010] [Accepted: 07/09/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND People confronted with oral cancer run a high risk of deteriorated masticatory performance. Reduced masticatory function may affect quality of life and food choice. An altered food choice may result in lower intakes for key nutrients and weight loss. METHODS Dental state, bite force, and masticatory performance were determined in a group of 45 patients with squamous cell carcinoma of the tongue and/or floor of mouth. Measurements were performed before surgery and at various moments after surgery and/or radiotherapy. RESULTS Surgical intervention had a large negative impact on oral function. Radiotherapy further worsened oral function. Also, the recovery of oral function 1 year after surgery was less prominent for the surgery-radiotherapy group than for the surgery group. CONCLUSION Objective determination of oral function 1 year after surgery showed that patients treated for malignancies in the tongue and/or floor of mouth had significantly deteriorated masticatory performance, bite force, and dental state.
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Affiliation(s)
- Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery, Prosthodontics, and Special Dental Care, University Medical Center Utrecht, PO Box 85.060, NL 3508 AB Utrecht, The Netherlands.
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Rogers S, Forgie S, Lowe D, Precious L, Haran S, Tschiesner U. Development of the International Classification of Functioning, Disability and Health as a brief head and neck cancer patient questionnaire. Int J Oral Maxillofac Surg 2010; 39:975-82. [DOI: 10.1016/j.ijom.2010.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
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Maciejewski O, Smeets R, Gerhards F, Kolk A, Kloss F, Stein JM, Kasaj A, Koch F, Grosjean M, Riediger D, Yekta SS. Gender specific quality of life in patients with oral squamous cell carcinomas. Head Face Med 2010; 6:21. [PMID: 20727183 PMCID: PMC2931465 DOI: 10.1186/1746-160x-6-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 08/20/2010] [Indexed: 01/22/2023] Open
Abstract
Background The goal of this study was to evaluate the somatic and psychological effects by means of QUALITY OF LIFE (QOL) of surgical treatment of patients with oral squamous cell carcinoma. The factors gender, age, nicotine consumption, and tumour stage were taken into consideration. Methods 54 patients after surgical resection of oral squamous cell carcinomas (OSCC) were analysed from 01.09.2005 to 31.05.2008. Inclusion criteria for the study were: age at least 18 years, no indication or treatment of synchronous and metachronous tumours. German translations of the EORTC H&N-35 and EORTC QLQ-C-30 questionnaires, as well as a general socioeconomic patient history were used as measuring instruments. The questionnaires were completed independently by the patients. The answers were translated into scale values for statistical evaluation using appropriate algorithms. Results Analysis of the EORTC-QLQ-C-30 questionnaires demonstrated a tendency of more negative assessment of emotional function among the female participants, and a more negative evaluation of social function among the male participants. Greater tumour sizes showed significantly lower bodily function (p = 0.018). While a smaller tumour size was significantly associated with lower cognitive functioning (p = 0.031). Other cofactors such as age, nicotine consumption, and tumour stage only showed a tendency to influence the quality of sleep and daily life. Conclusions The data obtained within this investigation demonstrated that gender had the most significant power on the subjectively perceived postoperative quality of life. This factor is important e.g. in preoperative decision making regarding immediate microvascular reconstruction after e.g. mandibular resection and therefore QOL assessment should become integral component of the care of patients with OSCC.
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Affiliation(s)
- Oliver Maciejewski
- University Hospital Aachen, Department of Oral and Maxillofacial Surgery, Aachen, Germany
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Oral function after oncological intervention in the oral cavity: a retrospective study. J Oral Maxillofac Surg 2010; 68:1231-7. [PMID: 20303207 DOI: 10.1016/j.joms.2009.09.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 09/09/2009] [Accepted: 09/11/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess self-perceived oral function of patients with oral cavity cancer at different stages of treatment, ie, before oncologic intervention, 5 weeks after intervention, and 5 years after intervention. PATIENTS AND METHODS A cohort of 158 patients with malignancy in the oral cavity treated by surgery in 1999 or 2000 was included. From this cohort we interviewed 69 patients by telephone in 2005 and collected data on dental status, disorders of chewing and swallowing, xerostomia, preference of food consistency, tube nutrition, weight loss, and speech for different stages of treatment. RESULTS For patients treated in the maxilla region we observed a significant (P < .05) recovery of perceived chewing ability after 5 years to the level experienced before oncologic intervention. Patients treated in the mandible region reported a deteriorated dental state, chewing ability, lip competence, and xerostomia after 5 years. Patients treated in the tongue and mouth-floor region experienced deterioration for dental state, chewing ability, and xerostomia after 5 years compared with the level before the oncologic intervention. CONCLUSIONS Our telephone interview on oral function provided supplementary information on how patients experienced their problems with oral function during various phases of oncologic treatment. A retrospective interview may thus help to add information to incomplete retrospective data.
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Scott B, D'Souza J, Perinparajah N, Lowe D, Rogers SN. Longitudinal evaluation of restricted mouth opening (trismus) in patients following primary surgery for oral and oropharyngeal squamous cell carcinoma. Br J Oral Maxillofac Surg 2010; 49:106-11. [PMID: 20236743 DOI: 10.1016/j.bjoms.2010.02.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 02/17/2010] [Indexed: 11/25/2022]
Abstract
Trismus is a serious problem for some patients after oral and oropharyngeal cancer, and it has a detrimental impact on quality of life and function. We know of few published papers that include preoperative assessment in reports on the longitudinal outcomes of mouth opening after oral and oropharyngeal surgery. We prospectively measured mouth opening in patients who had primary surgery for oral and oropharyngeal cancer from baseline to six months to find out the characteristics at baseline and at discharge of those who develop trismus at six months. Ninety-eight patients were eligible between February 2007 and March 2008, and 64 (65%) were recruited into the study. The range of mouth opening was measured on three occasions: before operation, on the ward before discharge from hospital, and at follow-up six months after operation. Using a criterion of 35 mm or less as an indication of trismus, 30% (19/63) had trismus before operation, 65% (37/57) at hospital discharge, and 54% (26/48) at six month follow-up. Patients at high risk of trismus were those with T stage 3 or 4 cancers who required free flap reconstruction and adjuvant radiotherapy; radiotherapy was the most significant factor at six months. Trismus at discharge was a prediction of trismus at six months. Interventions such as spatulas or a passive jaw mobiliser should be targeted at patients at high risk early in the postoperative phase. The efficacy of such interventions needs further research.
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Affiliation(s)
- B Scott
- Physiotherapy Department, Aintree University Hospitals NHS Foundation Trust, University Hospital Aintree, Longmoor Lane, Liverpool, UK.
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Using a cross-cheek anterolateral thigh flap for simultaneous correction of trismus and oral cancer. J Plast Reconstr Aesthet Surg 2010; 63:e28-31. [DOI: 10.1016/j.bjps.2009.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 05/09/2009] [Accepted: 05/20/2009] [Indexed: 11/23/2022]
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Van Cann EM. Preoperative examination of mandibular invasion by oral squamous cell carcinoma. J Oral Maxillofac Surg 2009; 68:228; author reply 228-9. [PMID: 20006185 DOI: 10.1016/j.joms.2009.05.444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Accepted: 05/28/2009] [Indexed: 11/25/2022]
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Infante-Cossio P, Torres-Carranza E, Cayuela A, Hens-Aumente E, Pastor-Gaitan P, Gutierrez-Perez JL. Impact of treatment on quality of life for oral and oropharyngeal carcinoma. Int J Oral Maxillofac Surg 2009; 38:1052-8. [PMID: 19596557 DOI: 10.1016/j.ijom.2009.06.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 01/20/2009] [Accepted: 06/15/2009] [Indexed: 10/20/2022]
Abstract
This study evaluates the changes in quality of life (QoL) from pre-treatment to 3 years after commencement of treatment and its relation to therapeutic variables in patients with oral and oropharyngeal carcinoma. QoL was assessed using the EORTC QLQ-C30 questionnaires and the EORTC head and neck cancer specific module QLQ-H&N35. QoL data were obtained prior to treatment and 1 and 3 years after treatment began. Of 128 patients, 69 completed all the questionnaires over the course of 3 years. Variable deterioration of QoL scores was detected before treatment. Most of the parameters worsened significantly after treatment and during the first year, and improved by the third year. Patients who underwent surgical treatment combined with adjuvant radiotherapy and chemotherapy generally showed worse scores and needed a long time to recover from the disease and the treatment adverse effects. This long-term prospective study performed using the EORCT questionnaires in a homogeneous group of patients with oral and oropharyngeal carcinoma may allow better understanding of the impact of treatment and the changes in QoL that occur.
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Affiliation(s)
- P Infante-Cossio
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, Seville, Spain.
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Chen SC, Liao CT, Lin CC, Chang JTC, Lai YH. Distress and care needs in newly diagnosed oral cavity cancer patients receiving surgery. Oral Oncol 2009; 45:815-20. [DOI: 10.1016/j.oraloncology.2009.01.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 12/25/2008] [Accepted: 01/02/2009] [Indexed: 11/16/2022]
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Dwivedi RC, Kazi RA, Agrawal N, Nutting CM, Clarke PM, Kerawala CJ, Rhys-Evans PH, Harrington KJ. Evaluation of speech outcomes following treatment of oral and oropharyngeal cancers. Cancer Treat Rev 2009; 35:417-24. [DOI: 10.1016/j.ctrv.2009.04.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 04/26/2009] [Indexed: 10/20/2022]
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Rogers SN. Quality of life for head and neck cancer patients – has treatment planning altered? Oral Oncol 2009; 45:435-9. [DOI: 10.1016/j.oraloncology.2008.11.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Patients who have cancers of the oral cavity, pharynx, or larynx may be treated with surgery, radiotherapy, chemotherapy, or a combination of these modalities. Each treatment type may have a negative impact on posttreatment swallowing function; these effects are presented in this article. A number of rehabilitative procedures are available to the clinician to reduce or eliminate swallowing disorders in patients treated for cancer of the head and neck. The various procedures-including postures, maneuvers, modifications to bolus volume and viscosity, range-of-motion exercises, and strengthening exercises-and their efficacy in patients treated for head and neck cancer are discussed.
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Affiliation(s)
- Barbara R Pauloski
- Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Suite 3-331, Evanston, IL 60208-3540, USA.
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Abstract
Reconstructive head and neck surgery is not unlike other surgical fields in its paucity of clinical research. Difficulties exist in the design and execution of surgical studies, and there are many challenges and limitations that must be addressed. In this article, the types of studies that make up head and neck reconstructive literature are reviewed, as well as the evolution toward the use of quality-of-life scales, which measure patients' satisfaction with their state of health and function.
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Affiliation(s)
- Carolyn Levis
- Department of Surgery, Division of Plastic and Reconstructive Surgery, St. Joseph's Healthcare, McMaster University, 50 Charlton Avenue East, Room G820, Hamilton, ON L8N 4A6, Canada.
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Borggreven PA, Aaronson NK, Verdonck-de Leeuw IM, Muller MJ, Heiligers MLCH, Bree RD, Langendijk JA, Leemans CR. Quality of life after surgical treatment for oral and oropharyngeal cancer: A prospective longitudinal assessment of patients reconstructed by a microvascular flap. Oral Oncol 2007; 43:1034-42. [PMID: 17307019 DOI: 10.1016/j.oraloncology.2006.11.017] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 11/23/2006] [Accepted: 11/23/2006] [Indexed: 01/22/2023]
Abstract
The aim of this study was to document changes from baseline to 6 and 12 months after treatment in health-related quality of life (HRQOL) in relation to sociodemographic and clinical parameters among advanced oral/oropharyngeal cancer patients treated with reconstructive surgery and adjuvant radiotherapy. The HRQOL of 80 consecutive patients was assessed by the EORTC QLQ-C30 and QLQ-H&N35 questionnaires, pretreatment and 6 and 12 months posttreatment. Several patterns of HRQOL changes were distinguished: most general HRQOL issues do not change after treatment or improve compared to baseline scores (emotional functioning, pain, insomnia, constipation) and most head and neck specific issues deteriorate after treatment but return to pretreatment levels at 12 months, except for senses, opening mouth, sticky saliva, and coughing which remain deteriorated in the long term. Although improvement to baseline levels was noted, it should be kept in mind that baseline levels of patients are often deviant from "normal" scores from the general population. Tumour site and stage, comorbidity, and extensive resections were significantly associated with HRQOL outcomes, as were marital status and age. These results, obtained in a homogenous group of patients, may serve as HRQOL benchmarks for future studies investigating surgical and other treatment modalities.
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Affiliation(s)
- Pepijn A Borggreven
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Hölzle F, Kesting MR, Hölzle G, Watola A, Loeffelbein DJ, Ervens J, Wolff KD. Clinical outcome and patient satisfaction after mandibular reconstruction with free fibula flaps. Int J Oral Maxillofac Surg 2007; 36:802-6. [PMID: 17614257 DOI: 10.1016/j.ijom.2007.04.013] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Revised: 03/19/2007] [Accepted: 04/28/2007] [Indexed: 11/22/2022]
Abstract
This study evaluated the difference between female and male patients' perception of functional and aesthetic outcomes after mandibular reconstruction with free fibular flaps, the transplant of choice for defects exceeding the length of half a mandible or the simultaneous covering of a soft-tissue defect. Based on clinical records, 54 patients with a mean postoperative follow up of 63 months were reviewed retrospectively. In addition, each patient completed a 12-item scaled questionnaire to assess perception of pain, speech, mastication and deglutition on recipient site, as well as pain, oedema, gait disturbances, difficulties in going upstairs and spraining on donor site. Functional scores on mastication were low for both sexes. The male group showed a higher rating of permanent or frequent difficulties in deglutition and speech. Aesthetic outcome for the recipient region was judged as poor by 62% of the female and 34% of the male patients. Donor site morbidity was described as mild by both sexes with excellent cosmetic results. The perception of facial changes appears to be impacted by gender. Female patients view the aesthetic results of mandibular reconstruction more negatively than do men, but express greater satisfaction with functional outcome. Objective clinician-rated measurements of the donor and recipient region do not always correlate with patient perception of outcome.
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Affiliation(s)
- F Hölzle
- Department of Oral and Maxillofacial Plastic Surgery, Ruhr-University Bochum, Knappschaftskrankenhaus Bochum-Langendreer, Bochum, Germany.
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Blackburn TK, Bakhtawar S, Brown JS, Lowe D, Vaughan ED, Rogers SN. A questionnaire survey of current UK practice for adjuvant radiotherapy following surgery for oral and oropharyngeal squamous cell carcinoma. Oral Oncol 2007; 43:143-9. [PMID: 16807074 DOI: 10.1016/j.oraloncology.2006.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 01/30/2006] [Indexed: 10/24/2022]
Abstract
A postal questionnaire was sent to 281 members of the British Association of Head and Neck Oncologists (BAHNO) to survey, which patients should receive adjuvant radiotherapy following primary surgery for oral and oropharyngeal squamous cell carcinoma (O&OSCC). Two hundred and one clinicians were involved in decision making for adjuvant radiotherapy in O&OSCC, of which, 132 (66%) responded. Apart from general agreement that patients with involved margins or extracapsular spread (ECS) should have adjuvant radiotherapy and that in patients with small tumours with clear margins and no neck metastasis, radiotherapy should be avoided, opinion was divided. Considerable variation in opinion in the UK was identified for a subgroup of intermediate risk patients as to whether they should have adjuvant radiotherapy. The majority of respondents (95%) would consider submitting patients to a prospective multi-centre trial. There is a need for research regarding adjuvant radiotherapy for O&OSCC patients at intermediate risk of relapse following primary surgery.
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Affiliation(s)
- Tim K Blackburn
- Merseyside Head and Neck Cancer Centre, Regional Maxillofacial Unit, University Hospital Aintree, Lower Lane, Liverpool, Merseyside L9 7AL, United Kingdom.
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Brown JS, Rogers SN, Lowe D. A comparison of tongue and soft palate squamous cell carcinoma treated by primary surgery in terms of survival and quality of life outcomes. Int J Oral Maxillofac Surg 2006; 35:208-14. [PMID: 16343850 DOI: 10.1016/j.ijom.2005.09.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Revised: 08/16/2005] [Accepted: 09/15/2005] [Indexed: 11/25/2022]
Abstract
In the surgical management of oral cancer the resection and reconstruction of the mobile tongue and soft palate are most important if function is to be maintained. The present trend towards primary laryngeal surgery for early disease has emphasized the importance of primary surgery if good functional outcomes can be achieved. This study compares the functional and health-related quality of life outcomes for primary surgery and reconstruction of the anterior tongue and soft palate. From a cohort of 566 patients treated from 1992 to 2002, 118 fitted the criteria for anterior tongue and 44 for soft palate resection. University of Washington Quality of Life scores were available in around three quarters of patients. In terms of speech and swallowing a 3/4 or total anterior glossectomy had a worse outcome than a 1/4 or 1/2. In patients having a 3/4 or total resection of the soft palate however, the results showed a similar outcome to those with 1/4 or 1/2 resection. The functional results of 3/4 and total soft palate reconstruction were superior to 3/4 and total anterior tongue resections and were similar to the whole cohort. This finding extends the role of functional surgery in the oropharynx for which primary radiotherapy is often preferred to preserve function.
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Affiliation(s)
- J S Brown
- Regional Maxillofacial Unit, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK.
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Van Cann EM, Dom M, Koole R, Merkx MAW, Stoelinga PJW. Health related quality of life after mandibular resection for oral and oropharyngeal squamous cell carcinoma. Oral Oncol 2006; 41:687-93. [PMID: 15927521 DOI: 10.1016/j.oraloncology.2005.03.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 03/02/2005] [Indexed: 11/12/2022]
Abstract
The impact of several clinical parameters on health related quality of life (HrQOL) was evaluated in patients with squamous cell carcinoma adjacent or fixed to the mandible with special emphasis on postoperative radiotherapy and type of mandibular resection. One-hundred and five returned EORTC-questionnaires were available for this study. Correlation analyses were used to determine the relationship between clinical parameters and HrQOL. Postoperative radiotherapy was the clinical parameter that affected HrQOL most. The type of mandibular resection had no influence on HrQOL. The affected QOL-items were all associated with eating problems, i.e. use of a feeding tube, use of nutritional supplements, swallowing, social eating, mouth opening and dry mouth. Postoperative radiotherapy should only be applied if strictly indicated. This implies that the application of postoperative radiotherapy may need reconsideration in cases without strict criteria for postoperative radiotherapy.
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Affiliation(s)
- Ellen M Van Cann
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 14, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Abstract
For advanced head and neck cancer (HNC) patients, aggressive radiation and chemoradiation treatments offer new therapy options. The aims of these regimens are increased survival and organ preservation, with the goals of preserving organ function, minimizing late effects, and improving quality of life (QOL). At the same time, the toxicities of these regimens are acknowledged as is the potential for long-term dysfunction. Thus, particularly now, with the increasing use of aggressive chemoradiation therapy (CRT) regimens, documentation of the QOL and functional outcomes of these treatments is critical. The implications for speech and swallowing are widely recognized and the broader effects of these impairments on overall QOL have received some attention. This article presents data on the performance, functional, and QOL results of radiation therapy (RT) and various CRT regimens in HNC.
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Affiliation(s)
- Marcy A List
- University of Chicago Cancer Research Center, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637-1470, USA.
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Rogers SN, Lowe D, Fisher SE, Brown JS, Vaughan ED. Health-related quality of life and clinical function after primary surgery for oral cancer. Br J Oral Maxillofac Surg 2002; 40:11-8. [PMID: 11883963 DOI: 10.1054/bjom.2001.0706] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Clinical function and health-related quality of life (HRQoL) are both important outcome parameters following surgery for oral and oropharyngeal cancer. The aim of this project was to explore the relationship between an 11-point clinical examination and HRQoL. Of 132 consecutive patients undergoing surgery for previously untreated disease between January 1995 and June 1997, 130 were recruited into the study. The University of Washington Quality of Life Questionnaire (UW-QoL) was completed by each patient on the day before operation and 6 and 12 months later. On each occasion the first author made an 11-point clinical examination. The main predictors of cumulative UW-QoL scores were tumour size, clinical functional score and type of operation. The trend was for a fall from preoperative levels at 6 months and then for a slight improvement at 1 year. The differential in respect of baseline function was present at all three time points in each patient group. This suggests that functional deficits at presentation persist following treatment.
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Affiliation(s)
- S N Rogers
- Regional Maxillofacial Unit, University Hospital Aintree, Aintree Trust, Liverpool, UK.
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