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Huang RS, Benour A, Wong Riff KWY. Survival and infection rates of microvascular free flaps in pediatric mandibular reconstruction: A systematic review and meta-analysis. Microsurgery 2024; 44:e31200. [PMID: 38828556 DOI: 10.1002/micr.31200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/08/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Vascularized free tissue transfer has been established as an effective method in the reconstruction of mandibular defects. However, a limited understanding of its efficacy in pediatric patients persists due to its infrequent presentation. The aim of this study is to systematically consolidate the survival and infection rates of free flaps in pediatric mandibular reconstruction. METHODS A systematic literature search was conducted on Ovid Medline, Embase, and Cochrane Library for studies published up to January 2024. We included peer-reviewed studies reporting on survival and infection outcomes associated with free flap mandibular reconstruction in pediatric patients (<18 years). We performed a random-effects meta-analysis with the inverse-variance weighted approach to estimate survival and infection rates. Heterogeneity was assessed by I2, and publication bias was examined using Egger's test. RESULTS A total of 26 studies, reporting on 463 free flaps and 439 pediatric patients with a mean age of 10.7 years, were included in our study. Most free flaps originated from the fibula (n = 392/463, 84.7%) and benign tumors were the most common cause for mandibular reconstruction (n = 179/463, 38.7%). The pooled estimate for survival of flaps was 96% (95% CI: 93-97, I2 = 0%), and recipient-site infections were estimated to occur in 9% (95% CI: 6-13, I2 = 0%) of cases. The most common reported complications within the study timeframe were early malocclusion (n = 28/123, 21.4%) and bite abnormalities (18/131, 13.7%). CONCLUSION Free tissue transfer for mandibular reconstruction in pediatric patients is effective and safe. Further research is required to explore functionality following mandibular reconstruction in diverse pediatric populations.
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Affiliation(s)
- Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ali Benour
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland
| | - Karen W Y Wong Riff
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Viswanath S, Sreekumar S, Janakiram C, Nayar S, Mathew A. Treatment outcomes in maxillofacial rehabilitation: a scoping review protocol. JBI Evid Synth 2024:02174543-990000000-00316. [PMID: 38832456 DOI: 10.11124/jbies-23-00100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE The objective of this scoping review is to assess the treatment outcomes following maxillofacial rehabilitation and to identify the tools used to evaluate those outcomes. INTRODUCTION Maxillofacial defects caused due to tumor, trauma, or any pathology affects the patient physically, mentally, and psychologically. Various methodologies and strategies are used for jaw reconstruction and oral rehabilitation to help the patient regain the functions and quality of life that were lost due to the defect. The evaluation of these treatment outcomes is imperative to assess the success of rehabilitation. INCLUSION CRITERIA The review will include patients with any maxillofacial defect caused by a developmental anomaly, trauma, or tumor. The patients must have undergone any type of reconstruction and/or rehabilitation and can be from any age group. All treatment outcomes of maxillofacial rehabilitation will be considered. Information from primary and secondary sources and from diverse geographical settings will be included. METHODS This review will follow the JBI methodology for scoping reviews. Databases to be searched will include PubMed (Ovid), Scopus, PsycINFO (EBSCOhost), CINAHL(EBSCO), Web of Science, Cochrane CENTRAL, ProQuest Dissertations and Theses, and Google Scholar (first 10 pages of the search). Two independent reviewers will screen the titles and abstracts and extract data from selected studies. Data will be presented in tabular format, accompanied by a narrative summary. DETAILS OF THE REVIEW CAN BE FOUND IN OPEN SCIENCE FRAMEWORK https://doi.org/10.17605/OSF.IO/DP8WC.
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Affiliation(s)
| | - Saranya Sreekumar
- Department of Prosthodontics, Amrita School of Dentistry, Kochi, Kerala, India
- Amrita Center for Evidence-based Oral Health: A JBI Center of Excellence, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Chandrasekhar Janakiram
- Amrita Center for Evidence-based Oral Health: A JBI Center of Excellence, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
- Department of Public Health Dentistry, Amrita School of Dentistry, Kochi, Kerala, India
| | - Suresh Nayar
- Institute for Reconstructive Sciences in Medicine, University of Alberta, Edmonton, AB, Canada
| | - Anil Mathew
- Department of Prosthodontics, Amrita School of Dentistry, Kochi, Kerala, India
- Amrita Center for Evidence-based Oral Health: A JBI Center of Excellence, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Vermaire JA, Partoredjo ASK, de Groot RJ, Brand HS, Speksnijder CM. Mastication in health-related quality of life in patients treated for oral cancer: A systematic review. Eur J Cancer Care (Engl) 2022; 31:e13744. [PMID: 36239005 PMCID: PMC9787816 DOI: 10.1111/ecc.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 09/14/2022] [Accepted: 09/27/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Treatment for oral cancer can impair oral functions such as mastication, which may negatively affect quality of life (QoL). In this review, an overview is provided of masticatory ability in patients treated for oral cancer. METHODS The PubMed (MEDLINE), Embase and Cochrane databases were systematically searched for scientific literature on masticatory ability in relation to QoL in patients treated for oral cancer. Studies were included when oral cancer treatment was provided, and the University of Washington Quality of Life (UW-QoL) questionnaire was used. Risk of bias (MINORS) was independently assessed by two authors. RESULTS The PubMed (MEDLINE), Embase and Cochrane search yielded 575 unique records of which 111 were assessed full text, and 27 studies were included. The UW-QoL mastication scores ranged from 31.9 to 97.4. There was a wide variety in methodology, patient groups, tumour site, treatment and assessment moment, to such a degree that outcome scores are difficult to compare. CONCLUSION The wide variety in studies exploring health-related QoL in relation to mastication in oral cancer patients prevents the identification of possible relations between treatment, masticatory ability and QoL. Our findings underline the limitations in currently available literature and indicate the necessity for more comparable research.
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Affiliation(s)
- Jorine A. Vermaire
- Imaging Division, Department of Radiation Oncology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Abbergayle S. K. Partoredjo
- Department of Oral and Maxillofacial Surgery and Special Dental Care, Department of Head and Neck Surgical Oncology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,Department of Oral BiochemistryAcademic Centre for Dentistry Amsterdam (ACTA)AmsterdamThe Netherlands
| | - Reilly J. de Groot
- Department of Oral and Maxillofacial Surgery and Special Dental Care, Department of Head and Neck Surgical Oncology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Henk S. Brand
- Department of Oral BiochemistryAcademic Centre for Dentistry Amsterdam (ACTA)AmsterdamThe Netherlands
| | - Caroline M. Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, Department of Head and Neck Surgical Oncology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,Department of Head and Neck Surgical Oncology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
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4
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Ogawa H, McKenna G, Kettratad-Pruksapong M. Prevention of Oral Functional Decline. Int Dent J 2022; 72:S21-S26. [PMID: 36031322 PMCID: PMC9437790 DOI: 10.1016/j.identj.2022.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The oral cavity functions in eating, speaking, socializing, and serving as a natural barrier to external pathogens. In the prevention of oral function decline in older people, oral health conditions should be maintained through public health actions. METHODS This article discusses public health actions to prevent oral functional decline through addressing three major issues among older people: tooth loss, hyposalivation, and oral cancer. Negative impacts of tooth loss, hyposalivation, and oral cancer will be described, followed by describing public health approaches to prevent these problems RESULTS: Tooth loss, commonly caused by dental caries and periodontal diseases, affects one's ability to eat, speak, and socialize freely. Prevention of tooth loss can be done in clinical settings, community settings, and through national policies. Saliva plays an important role in eating, swallowing, and protecting oral mucosa from pathogens. The major causes of dry mouth are polypharmacy and the use of anticholinergic medications among older people. Public health actions to promote collaboration between dentists and doctors in the adjustment of drug prescriptions are warranted. Oral cancer can affect oral function largely both from the disease itself and from cancer treatments due to the destruction of oral structures and salivary gland function. Tobacco use and alcohol consumption are major risk factors for oral cancer; they also contribute to various systemic diseases and cancers of other organs. CONCLUSIONS Public health policies and interventions using the common risk factor approaches to tackle tobacco and alcohol consumption should be encouraged. Rather than focusing on older people, the prevention of oral function decline should be planned through a life-course perspective.
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Affiliation(s)
- Hiroshi Ogawa
- Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
| | - Gerry McKenna
- Centre for Public Health, Queens University Belfast, Belfast, UK
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5
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Zavala A, Ore JF, Broggi A, De Pawlikowski W. Pediatric Mandibular Reconstruction Using the Vascularized Fibula Free Flap: Functional Outcomes in 34 Consecutive Patients. Ann Plast Surg 2021; 87:662-668. [PMID: 34334671 DOI: 10.1097/sap.0000000000002963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The vascularized fibula free flap is a workhorse flap in pediatric mandibular reconstruction. This study aimed to address functional outcomes, complications, and morbidity associated with the fibula resection in a consecutive series of mandibular reconstruction using this technique in skeletally immature patients. METHODS Functional outcomes in terms of maximal mouth opening capacity, patient-reported eating ability, occlusion, and gait were retrospectively reviewed in 34 consecutive pediatric patients (18 males, 16 females) who underwent mandibular reconstruction using the vascularized free fibula flap. Data regarding donor and recipient site complications were also retrieved. RESULTS The mean follow-up period was 50.6 months (range, 12-108 months). The average age was 10.3 years (range, 2-15 years). Underlying pathologies included ossifying fibroma, ameloblastoma, mandibular arteriovenous malformation, fibrous dysplasia, Goldenhar syndrome, dentigerous cyst, mandibular lymphoma, odontogenic fibroma, adenomatoid odontogenic tumor, aneurysmal bone cyst, neurogenic sarcoma, and central giant cell granuloma. Defect length ranged from 8 to 17 cm. Mean return to normal ambulation was achieved 12 days postoperatively. All patients reported ability to eat solids and liquids, with 29 of 34 achieving normal mouth opening. Normal or minimally disturbed occlusion was maintained postoperatively in most patients. Temporomandibular joint ankylosis and condylar displacement were each developed in one patient. Two patients reported gait disturbances that receded after physical therapy. No other major donor site complications, including flexion contracture of the great toe, were identified. CONCLUSIONS The vascularized fibula free flap is reaffirmed to be the criterion standard for mandible reconstruction in pediatric patients, providing satisfactory functional results and adequate adaptation to the growing facial skeleton with minimal sequelae. Complications regarding hallux function may be prevented by assessing the vascularity of the flexor hallucis longus intraoperatively and ensuring tension-free closure of the donor site.
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Affiliation(s)
- Abraham Zavala
- From the Department of Plastic and Reconstructive Surgery
| | - Juan F Ore
- Department of Head and Neck Surgery, Instituto Nacional de Salud del Niño - San Borja, Lima, Peru
| | - Alfredo Broggi
- Department of Head and Neck Surgery, Instituto Nacional de Salud del Niño - San Borja, Lima, Peru
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Mochizuki Y, Marukawa E, Harada H, Kinoshita N, Nakatani R, Oikawa Y, Hirai H, Tomioka H, Yoda T, Nakamura S, Kurabayashi T. Postoperative morphological changes over time of vascularized scapular bone used for mandibular reconstruction: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2021; 74:1984-1990. [PMID: 33785268 DOI: 10.1016/j.bjps.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/21/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Currently, sequential morphological changes of vascularized scapular bone for mandibular reconstruction have remained unreported. METHODS We retrospectively analyzed 18 patients with defects on the lateral segment of the mandible who underwent postoperative computed tomography (CT) scanning at 1, 6, 12, and 24 months postoperatively. Using the cross-sectional coronal CT images during each assessment, we measured the height and thickness of the grafted scapular bone at points 10 and 30 mm away from the mesial segment and evaluated their differences over time. Then, the relationship between the morphological changes of the grafted scapular bone and the distance from the mesial bone segment, the number of occlusal supports on the contralateral side of the mandible, and the correlation of sex and age were evaluated. RESULTS The height of the grafted scapular bone decreased by approximately 11% and its thickness increased by 14% within 24 months postoperatively. The bone thickness increase was greater at point 30 mm from the mesial bone segment. Patients with two occlusal contacts (premolar and molar) on the contralateral side had a significantly higher rate of bone thickness increase. Furthermore, the graft morphology was not associated with age or sex. CONCLUSION A vascularized scapular bone thickens over time, which depends on the distance from the mesial bone segment and the occlusal contact regions on the contralateral side of the mandible.
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Affiliation(s)
- Yumi Mochizuki
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.
| | - Eriko Marukawa
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Naoya Kinoshita
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Ryo Nakatani
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Yu Oikawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Hideaki Hirai
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Hirofumi Tomioka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Tetsuya Yoda
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Shin Nakamura
- Department of Oral and Maxillofacial Radiology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Tohru Kurabayashi
- Department of Oral and Maxillofacial Radiology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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7
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Paré A, Bossard A, Laure B, Weiss P, Gauthier O, Corre P. Reconstruction of segmental mandibular defects: Current procedures and perspectives. Laryngoscope Investig Otolaryngol 2019; 4:587-596. [PMID: 31890875 PMCID: PMC6929581 DOI: 10.1002/lio2.325] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/02/2019] [Accepted: 10/21/2019] [Indexed: 11/11/2022] Open
Abstract
Background The reconstruction of segmental mandibular defects remains a challenge for the reconstructive surgeon, from both a functional and an esthetic point of view. Methods This clinical review examines the different techniques currently in use for mandibular reconstruction as related to a range of etiologies, including the different bone donor sites, the alternatives to free flaps (FFs), as well as the contribution of computer‐assisted surgery. Recent progress and the perspectives in bone tissue engineering (BTE) are also discussed. Results Osseous FF allows reliable and satisfying outcomes. However, locoregional flap, distraction osteogenesis, or even induced membrane techniques are other potential options in less favorable cases. Obtaining an engineered bone with satisfactory mechanical properties and sufficient vascular supply requires further investigations. Conclusions Osseous FF procedure remains the gold standard for segmental mandible reconstruction. BTE strategies offer promising alternatives.
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Affiliation(s)
- Arnaud Paré
- Service de Chirurgie Maxillo Faciale Plastique et Brulés, Hôpital Trousseau, CHU de Tours Tours France.,Laboratoire Regenerative Medicine and Skeleton RMeS, France INSERM, U 1229 Nantes France.,UFR Médecine Université de Tours Tours France.,UFR Odontologie Université́ de Nantes Nantes France
| | - Adeline Bossard
- ONIRIS Nantes-Atlantic College of Veterinary Medicine Centre de Rechecherche et D'investigation Préclinique (CRIP) Nantes France
| | - Boris Laure
- Service de Chirurgie Maxillo Faciale Plastique et Brulés, Hôpital Trousseau, CHU de Tours Tours France
| | - Pierre Weiss
- Laboratoire Regenerative Medicine and Skeleton RMeS, France INSERM, U 1229 Nantes France.,UFR Odontologie Université́ de Nantes Nantes France
| | - Olivier Gauthier
- Laboratoire Regenerative Medicine and Skeleton RMeS, France INSERM, U 1229 Nantes France.,ONIRIS Nantes-Atlantic College of Veterinary Medicine Centre de Rechecherche et D'investigation Préclinique (CRIP) Nantes France
| | - Pierre Corre
- Laboratoire Regenerative Medicine and Skeleton RMeS, France INSERM, U 1229 Nantes France.,UFR Odontologie Université́ de Nantes Nantes France.,Service de Chirurgie Maxillo-Faciale et Stomatologie CHU de Nantes Nantes France
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8
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Hong KDG, Kim SG, Park YW. The effect of fixation plate use on bone healing during the reconstruction of mandibular defects. J Korean Assoc Oral Maxillofac Surg 2019; 45:276-284. [PMID: 31728335 PMCID: PMC6838356 DOI: 10.5125/jkaoms.2019.45.5.276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 11/12/2022] Open
Abstract
Objectives This study sought to compare efficiency results between the use of a customized implant (CI) and a reconstruction plate (RP) in mandibular defect reconstruction in an animal model. Materials and Methods Fifteen rabbits underwent surgery to create a defect in the right side of the mandible and were randomly divided into two groups. For reconstruction of the mandibular defect, the RP group (n=5) received five-hole mini-plates without bone grafting and the CI group (n=10) received fabricated CIs based on the cone-beam computed tomography (CBCT) data taken preoperatively. The CI group was further divided into two subgroups depending on the time of CBCT performance preoperatively, as follows: a six-week CI (6WCI) group (n=5) and a one-week CI (1WCI) group (n=5). Daily food intake amount (DFIA) was measured to assess the recovery rate. Radiographic images were acquired to evaluate screw quantity. CBCT and histological examination were performed in the CI subgroup after sacrifice. Results The 1WCI group showed the highest value in peak average recovery rate and the fastest average recovery rate. In terms of reaching a 50% recovery rate, the 1WCI group required the least number of days as compared with the other groups (2.6±1.3 days), while the RP group required the least number of days to reach an 80% recovery rate (7.8±2.2 days). The 1WCI group showed the highest percentage of intact screws (94.3%). New bone formation was observed in the CI group during histological examination. Conclusion Rabbits with mandibular defects treated with CI showed higher and faster recovery rates and more favorable screw status as compared with those treated with a five-hole mini-plate without bone graft.
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Affiliation(s)
- Khang Do Gia Hong
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Seong-Gon Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Young-Wook Park
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
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Depeyre A, Pereira B, Pham-Dang N, Barthélémy I, Hennequin M. Impairments in Food Oral Processing in Patients Treated for Tongue Cancer. Dysphagia 2019; 35:494-502. [PMID: 31598793 DOI: 10.1007/s00455-019-10054-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 08/21/2019] [Indexed: 12/14/2022]
Abstract
Patients surgically treated for oral cancer are affected by several underestimated deglutition disorders risk factors. This study aims to characterize the level of these food oral processing (FOP) impairments in a group of patients treated by surgery for tongue cancer. Twenty-seven consecutive patients surgically treated for tongue cancer were evaluated concerning their chewing capacity (Mastication-test), and responded to questions concerning their capacity to bite, chew and manipulate food with their tongue, and their quality of life. According to the Mastication-test, 16 patients suffered total FOP incapacities (TI group), characterized by high tumor stage, invasive carcinological surgery and necessity of reconstructive surgery; 12 patients were partially or not impaired (PI/NI-group). Tongue movement score and number of dental units were lower in the TI group than in the PI/NI-group. Subjective FOP criteria were clearly impaired in the TI group and correlated with a poor oral health-related quality of life. One year after surgery, there is a decrease in BMI for TI group patients while the PI group patients had a significant increase in BMI. All patients surgically treated for oral cancer suffered FOP impairments, but not with the same severity. Totally impaired subjects are at higher risk from long-term malnutrition. Functional evaluation of FOP should form part of the post-operative follow-up for all patients suffering from tongue cancer, using a quick combined evaluation of chewing efficiency, oral health quality of life and nutritional status.
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Affiliation(s)
- Arnaud Depeyre
- Université Clermont Auvergne, CROC EA4847, 63000, Clermont-Ferrand, France.,CHU de Clermont-Ferrand, Service de Chirurgie Maxillo-Faciale, 63003, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU de Clermont-Ferrand, Département de Biostatistiques, 63003, Clermont-Ferrand, France
| | - Nathalie Pham-Dang
- CHU de Clermont-Ferrand, Service de Chirurgie Maxillo-Faciale, 63003, Clermont-Ferrand, France.,Université Clermont Auvergne, Faculté de Médecine et des professions paramédicales, 63000, Clermont-Ferrand, France
| | - Isabelle Barthélémy
- CHU de Clermont-Ferrand, Service de Chirurgie Maxillo-Faciale, 63003, Clermont-Ferrand, France.,Université Clermont Auvergne, Faculté de Médecine et des professions paramédicales, 63000, Clermont-Ferrand, France
| | - Martine Hennequin
- Université Clermont Auvergne, CROC EA4847, 63000, Clermont-Ferrand, France. .,CHU de Clermont-Ferrand, Service d'Odontologie, 63003, Clermont-Ferrand, France. .,Faculté de Chirurgie Dentaire, 2, rue de Braga, 63000, Clermont-Ferrand, France.
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10
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Arzi B, Verstraete FJM, Garcia TC, Lee M, Kim SE, Stover SM. Kinematic analysis of mandibular motion before and after mandibulectomy and mandibular reconstruction in dogs. Am J Vet Res 2019; 80:637-645. [PMID: 31246128 DOI: 10.2460/ajvr.80.7.637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate and quantify the kinematic behavior of canine mandibles before and after bilateral rostral or unilateral segmental mandibulectomy as well as after mandibular reconstruction with a locking reconstruction plate in ex vivo conditions. SAMPLE Head specimens from cadavers of 16 dogs (range in body weight, 30 to 35 kg). PROCEDURE Specimens were assigned to undergo unilateral segmental (n = 8) or bilateral rostral (8) mandibulectomy and then mandibular reconstruction by internal fixation with locking plates. Kinematic markers were attached to each specimen in a custom-built load frame. Markers were tracked in 3-D space during standardized loading conditions, and mandibular motions were quantified. Differences in mandibular range of motion among 3 experimental conditions (before mandibulectomy [ie, with mandibles intact], after mandibulectomy, and after reconstruction) were assessed by means of repeated-measures ANOVA. RESULTS Both unilateral segmental and bilateral rostral mandibulectomy resulted in significantly greater mandibular motion and instability, compared with results for intact mandibles. No significant differences in motion were detected between mandibles reconstructed after unilateral segmental mandibulectomy and intact mandibles. Similarly, the motion of mandibles reconstructed after rostral mandibulectomy was no different from that of intact mandibles, except in the lateral direction. CONCLUSIONS AND CLINICAL RELEVANCE Mandibular kinematics in head specimens from canine cadavers were significantly altered after unilateral segmental and bilateral rostral mandibulectomy. These alterations were corrected after mandibular reconstruction with locking reconstruction plates. Findings reinforced the clinical observations of the beneficial effect of reconstruction on mandibular function and the need for reconstructive surgery after mandibulectomy in dogs.
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11
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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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12
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Zheng K, Liao Z, Yoda N, Fang J, Chen J, Zhang Z, Zhong J, Peck C, Sasaki K, Swain MV, Li Q. Investigation on masticatory muscular functionality following oral reconstruction – An inverse identification approach. J Biomech 2019; 90:1-8. [DOI: 10.1016/j.jbiomech.2019.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 11/28/2022]
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13
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Dholam KP, Sadashiva KM, Gurav S. Study of Quality of Life in Patients with Soft Tissue Reconstruction Following Mandibulectomy. J Maxillofac Oral Surg 2019; 18:266-272. [PMID: 30996550 DOI: 10.1007/s12663-018-1122-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 05/08/2018] [Indexed: 11/12/2022] Open
Abstract
Purpose To study the effect of mandibulectomy with soft tissue reconstruction on quality of life (QOL) and functions of speech and swallowing. Methodology Quality of life of 66 patients was evaluated by using EORTC QLQ-C30 and EORTC-HN35 questionnaires. Speech was evaluated objectively by Dr. Speech software version 4 and subjectively by a single speech therapist along with swallowing. Patients were evaluated preoperatively and 6 months after treatment. Results Out of 66 patients, 57 followed up postoperatively. Comparison of preoperative and postoperative QOL, speech, and swallowing was done by using paired 't' test or Wilcoxon signed-rank test as per distribution. When evaluated by EORTC QLQ-C30 and EORTC-HN35, statistically significant difference was found in the domains of physical function, fatigue, nausea-vomiting, dyspnea and appetite loss, pain, nutrition, swallowing speech and dry mouth. Significant difference was found in speech (maximum intensity) and most of the domains of swallowing. Conclusion In EORTC QLQ-C30 questionnaire, all functional scales showed deterioration with maximum in physical function. Symptom scales showed worsening but significant improvement was found in pain when evaluated by EORTC-HN35. However, the global health status/QL was found to be improved marginally.
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Affiliation(s)
- Kanchan P Dholam
- 1Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, HBNI, Room No 217, Homi Bhabha Block, Dr. E Borges Marg, Parel, Mumbai, 400012 India
| | - Karthik M Sadashiva
- The Sultan's Special Force, Way No 6231, House No 2520, Post box No 331- C.P.O., 111 Azaiba, Muscat, Oman
| | - Sandeep Gurav
- 1Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, HBNI, Room No 217, Homi Bhabha Block, Dr. E Borges Marg, Parel, Mumbai, 400012 India
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14
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de Groot RJ, Wetzels JW, Merkx MAW, Rosenberg AJWP, de Haan AFJ, van der Bilt A, Abbink JH, Speksnijder CM. Masticatory function and related factors after oral oncological treatment: A 5-year prospective study. Head Neck 2018; 41:216-224. [PMID: 30552819 PMCID: PMC6590803 DOI: 10.1002/hed.25445] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/18/2018] [Accepted: 07/18/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Chewing ability is often compromised in patients with oral cancer. The aim of this study was to identify which factors affect masticatory performance in these patients. METHODS Patients with primary oral cancer were assessed for up to 5 years after primary treatment. Healthy controls were assessed once. A mixed-model analysis was performed, with masticatory performance as outcome measure. RESULTS A total of 123 patients were included in the study. Factors positively associated with masticatory performance were number of occlusal units (OU), having functional dentures, and maximum mouth opening (MMO). The impact of tumor location and maximum bite force (MBF) differed per assessment moment. Masticatory performance declined for up to 1 year but recovered at 5 years after treatment. CONCLUSION Masticatory performance in patients treated for oral cancer is affected by MBF, MMO, number of OU, and dental status. These should be the focus of posttreatment therapy.
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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, The Netherlands
| | - Jan-Willem Wetzels
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery, 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, The Netherlands
| | - Anton F J de Haan
- Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andries van der Bilt
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan H Abbink
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Julius Center Sciences, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
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15
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de Groot RJ, Rosenberg AJWP, van der Bilt A, Aalto D, Merkx MAW, Speksnijder CM. The association between a mixing ability test and patient reported chewing ability in patients treated for oral malignancies. J Oral Rehabil 2018; 46:140-150. [PMID: 30311256 PMCID: PMC7379969 DOI: 10.1111/joor.12734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/03/2018] [Accepted: 10/07/2018] [Indexed: 01/25/2023]
Abstract
Introduction Mastication has been assessed in several ways in the past. Both patients reported and objective assessment methods have been developed. The University Medical Center (UMC) Utrecht has developed a mixing ability test (MAT) using a two‐coloured wax tablet. The present study investigates the association between the mixing ability test and a chewing related questionnaire in patients treated for oral malignancies. Patients and methods In a cohort study, patients treated for oral malignancies were assessed 4‐6 weeks before and 4‐6 weeks after treatment, as well as 6 months, 1 year and 5 years after treatment. The mixing ability test was assessed using 10 and 20 chewing strokes and was compared to seven questions about several aspects of mastication. Regression analysis was performed and density plots were drawn for statistical analysis. Results One hundred and twenty‐three patients were included in this study. The questionnaire was less predictive for the 10‐chewing stroke test and the test was less discriminatory for different food types than the 20‐chewing stroke mixing ability test. Three questions about the ability to chew solid, soft and thickened liquid food types were found to be significantly predictive for the 20‐chewing stroke test. Threshold values on the mixing ability index were around 20 for the ability to chew solid food types and 24 for soft food types. Conclusion The 10‐chewing stroke mixing ability test is less suitable than 20‐chewing strokes for patients with and treated for oral cancer. The 20‐chewing stroke mixing ability test has a fair association with self‐reported outcomes.
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Affiliation(s)
- Reilly J de Groot
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Andries van der Bilt
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Daniel Aalto
- Faculty of Rehabilitation Medicine, Department of Communication Sciences and Disorders, University of Alberta, Edmonton, Alberta, Canada.,Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.,Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Julius Center Sciences, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, University Medical Center Utrecht Cancer Center, University Utrecht, Utrecht, The Netherlands
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16
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Yoda N, Zheng K, Chen J, Liao Z, Koyama S, Peck C, Swain M, Sasaki K, Li Q. Biomechanical analysis of bone remodeling following mandibular reconstruction using fibula free flap. Med Eng Phys 2018; 56:1-8. [DOI: 10.1016/j.medengphy.2018.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/24/2018] [Accepted: 03/13/2018] [Indexed: 02/06/2023]
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17
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Elucidating the masticatory function and oral quality of life according to the range of mandibulectomy. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2018. [DOI: 10.1016/j.ajoms.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Mustafa AA, Raad K, Mustafa NS. Effect of proper oral rehabilitation on general health of mandibulectomy patients. Clin Case Rep 2015; 3:907-11. [PMID: 26576270 PMCID: PMC4641472 DOI: 10.1002/ccr3.373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 05/19/2015] [Accepted: 08/13/2015] [Indexed: 11/29/2022] Open
Abstract
Here, we aimed to assess whether postoperative oral rehabilitation for mandibulectomy patients is necessary to improve patients’ general health in terms of health-related quality of life.
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Affiliation(s)
- Ammar A Mustafa
- Faculty of Dentistry, The University of Hong KongHong Kong, China
- ISF Medical ClinicDoha, Qatar
- Faculty of Dentistry, International Islamic University MalaysiaKuantan, Malaysia
- Correspondence Ammar A. Mustafa, ISF Medical Clinic, Doha, Qatar, Faculty of Dentistry, The University of Hong Kong and Faculty of Dentistry, International Islamic University Malaysia (2007-2014). Tel: 0097466231755; Fax: 00974-44779784; E-mail:
| | - Kais Raad
- Faculty of Dentistry, International Islamic University MalaysiaKuantan, Malaysia
| | - Nazih S Mustafa
- Faculty of Dentistry, International Islamic University MalaysiaKuantan, Malaysia
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19
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Ishida S, Shibuya Y, Kobayashi M, Komori T. Assessing stomatognathic performance after mandibulectomy according to the method of mandibular reconstruction. Int J Oral Maxillofac Surg 2015; 44:948-55. [DOI: 10.1016/j.ijom.2015.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/13/2015] [Accepted: 03/16/2015] [Indexed: 01/08/2023]
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20
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Blyth KM, McCabe P, Heard R, Clark J, Madill C, Ballard KJ. Cancers of the tongue and floor of mouth: five-year file audit within the acute phase. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 23:668-678. [PMID: 25089517 DOI: 10.1044/2014_ajslp-14-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 07/23/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE The impact of patient, surgical, and rehabilitation factors on speech and swallowing in the acute phase for patients following tongue and/or floor of mouth cancer surgery has not been reported to date. This study reviewed functional outcomes over a 5-year period at an Australian tertiary hospital. METHOD Patient medical files from July 2006 through 2011 were audited. Patient demographics, tumor and treatment, along with speech-language pathology (SLP) intervention details were examined. RESULTS Speech and swallow function were significantly different between those with primary closure and those requiring reconstruction, with significantly higher referral rate to SLP following reconstruction. The clinical speech and swallow function at SLP assessment following reconstruction was a predictor for the number of SLP intervention sessions provided. The number of intervention sessions provided to these patients significantly correlated with upgrade in fluids during hospitalization. CONCLUSION This is the first published study to report a relationship between function and dosage of clinical SLP intervention with this population. It is also the first known study to audit comprehensive functional outcomes in the acute phase of recovery with an Australian cohort. The findings contribute to establishing evidence-based SLP practice with this population.
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21
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Temiz G, Bilkay U, Tiftikçioğlu YÖ, Mezili CT, Songür E. The evaluation of flap growth and long-term results of pediatric mandible reconstructions using free fibular flaps. Microsurgery 2014; 35:253-61. [DOI: 10.1002/micr.22334] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 09/13/2014] [Accepted: 09/17/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Gökhan Temiz
- Department of Plastic Reconstructive and Aesthetic Surgery; Dr. Lütfi Kırdar Kartal Training And Research Hospital; Kartal İstanbul Turkey
| | - Ufuk Bilkay
- Department of Plastic and Reconstructive Surgery; Ege University School of Medicine; Izmir Turkey
| | - Yiğit Özer Tiftikçioğlu
- Department of Plastic and Reconstructive Surgery; Ege University School of Medicine; Izmir Turkey
| | - Candan Tevfik Mezili
- Department of Plastic and Reconstructive Surgery; Darıca Farabi General Hospital Kocaeli; Turkey
| | - Ecmel Songür
- Department of Plastic and Reconstructive Surgery; Ege University School of Medicine; Izmir Turkey
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22
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Zou D, Huang W, Wang F, Wang S, Zhang Z, Zhang C, Kaigler D, Wu Y. Autologous Ilium Grafts: Long-Term Results on Immediate or Staged Functional Rehabilitation of Mandibular Segmental Defects Using Dental Implants after Tumor Resection. Clin Implant Dent Relat Res 2013; 17:779-89. [PMID: 24172127 DOI: 10.1111/cid.12169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is a challenge for clinicians to restore oral function in patients with segmental defects of the mandible because of tumor extirpation. Dental implant therapy following vascularized autologous ilium grafts is an effective method to restore oral function in patients with mandibular segmental defects. PURPOSE The aim of this retrospective study was to investigate the long-term clinical outcomes of ilium grafts combined with immediate or staged mandibular dental implant therapy to restore craniofacial defects resulting from tumor resection. MATERIALS AND METHODS Over a 5-year period (2000-2004), 32 patients who underwent mandibular segmental resection for tumors were treated with vascularized ilium grafts to augment bone volume. Seventeen patients received phase I therapy (immediate placement of implants), and 15 patients underwent phase II therapy (delayed placement of implants). A total of 110 dental implants were placed in these patients for mandibular restoration of the defective areas. Information regarding implant success and survival rates, marginal bone loss, soft tissue inflammation, complications of prosthesis, and patient satisfaction for the 8 to 12 years following oral reconstruction was obtained from patient records. RESULTS Although there was mild evidence of bone graft resorption, the vascularized autogenous ilium bone grafts were successful in all patients. The cumulative patient survival and success rate of the implants were 96.4% and 91.8%, respectively. The mean peri-implant bone resorption ranged from 1.0 to 1.2 mm over the 8- to 12-year follow-up period. The annual mean number of complications/repairs was from 0.11 to 0.07 per patient during the 8- to 12-year follow-up. Over 80% of the patients were fully satisfied with their restoration of oral function. CONCLUSIONS This study demonstrates that reconstruction of mandibular segmental defects because of resection of mandibular tumors using dental implants therapy combined with vascularized autogenous ilium grafts is an effective method to restore oral function.
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Affiliation(s)
- Duohong Zou
- Departments of Oral and Craniofacial Implant and Oral and Maxillofacial Surgery, School of Medicine, Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China.,Department of Dental Implant Centre, Stomatologic Hospital & College, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei, China
| | - Wei Huang
- Departments of Oral and Craniofacial Implant and Oral and Maxillofacial Surgery, School of Medicine, Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Feng Wang
- Departments of Oral and Craniofacial Implant and Oral and Maxillofacial Surgery, School of Medicine, Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Shen Wang
- Departments of Oral and Craniofacial Implant and Oral and Maxillofacial Surgery, School of Medicine, Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyong Zhang
- Departments of Oral and Craniofacial Implant and Oral and Maxillofacial Surgery, School of Medicine, Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Chenpin Zhang
- Departments of Oral and Craniofacial Implant and Oral and Maxillofacial Surgery, School of Medicine, Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Darnell Kaigler
- Department of Periodontics and Oral Medicine in School of Dentistry, University of Michigan and Michigan Center of Oral Health Research (MCOHR), Ann Arbor, MI, USA
| | - Yiqun Wu
- Departments of Oral and Craniofacial Implant and Oral and Maxillofacial Surgery, School of Medicine, Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, Shanghai, China
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23
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Shibuya Y, Ishida S, Hasegawa T, Kobayashi M, Nibu K, Komori T. Evaluating the masticatory function after mandibulectomy with colour-changing chewing gum. J Oral Rehabil 2013; 40:484-90. [PMID: 23691949 DOI: 10.1111/joor.12066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2013] [Indexed: 11/30/2022]
Abstract
The aim of this study was to clarify the usefulness of colour-changing gum in evaluating masticatory performance after mandibulectomy. Thirty-nine patients who underwent mandibulectomy between 1982 and 2010 at Kobe University Hospital were recruited in this study. There were 21 male and 18 female subjects with a mean age of 64·7 years (range: 12-89 years) at the time of surgery. The participants included six patients who underwent marginal mandibulectomy, 21 patients who underwent segmental mandibulectomy and 12 patients who underwent hemimandibulectomy. The masticatory function was evaluated using colour-changing chewing gum, gummy jelly and a modified Sato's questionnaire. In all cases, the data were obtained more than 3 months after completing the patient's final prosthesis. The colour-changing gum scores correlated with both the gummy jelly scores (r = 0·634, P < 0·001) and the total scores of the modified Sato's questionnaire (r = 0·537, P < 0·001). In conclusion, colour-changing gum is a useful item for evaluating masticatory performance after mandibulectomy.
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Affiliation(s)
- Y Shibuya
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
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24
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Shibuya Y, Ishida S, Kobayashi M, Hasegawa T, Nibu K, Komori T. Evaluation of masticatory function after maxillectomy using a colour-changing chewing gum. J Oral Rehabil 2012; 40:191-8. [DOI: 10.1111/joor.12023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Y. Shibuya
- Department of Oral and Maxillofacial Surgery; Kobe University Graduate School of Medicine; Kobe Japan
| | - S. Ishida
- Department of Oral and Maxillofacial Surgery; Kobe University Graduate School of Medicine; Kobe Japan
| | - M. Kobayashi
- Department of Oral and Maxillofacial Surgery; Kobe University Graduate School of Medicine; Kobe Japan
| | - T. Hasegawa
- Department of Oral and Maxillofacial Surgery; Kobe University Graduate School of Medicine; Kobe Japan
| | - K. Nibu
- Department of Otolaryngology - Head and Neck Surgery; Kobe University Graduate School of Medicine; Kobe Japan
| | - T. Komori
- Department of Oral and Maxillofacial Surgery; Kobe University Graduate School of Medicine; Kobe Japan
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25
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Wolff KD, Follmann M, Nast A. The diagnosis and treatment of oral cavity cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:829-35. [PMID: 23248713 DOI: 10.3238/arztebl.2012.0829] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 10/04/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND About 10,000 persons are diagnosed as having carcinoma of the oral cavity or the throat in Germany every year. Squamous-cell carcinoma accounts for 95% of cases. METHODS We systematically reviewed the pertinent literature on predefined key questions about these tumors (which were agreed upon by a consensus of the investigators), concerning imaging, the removal of cervical lymph nodes, and resection of the primary tumor. RESULTS 246 clinical trials were selected for review on the basis of 3014 abstracts. There was only one randomized, controlled trial (evidence level 1-); the remaining trials reached evidence levels 2++ to 3. Patients with mucosal changes of an unclear nature persisting for more than two weeks should be examined by a specialist without delay. The diagnosis is made by computed tomography or magnetic resonance imaging along with biopsy and a standardized histopathological examination. Occult metastases are present in 20% to 40% of cases. Advanced disease (stages T3 and T4) should be treated by surgery followed by radiotherapy, with or without chemotherapy. 20% of the patients overall go on to have a recurrence, usually within 2 to 3 years of the initial treatment. The 5-year survival rate is somewhat above 50%. Depending on the radicality of surgery and radiotherapy, there may be functional deficits, osteoradionecrosis, and xerostomia. The rate of loss of implants in irradiated bone is about 10% in 3 years. CONCLUSION The interdisciplinary planning and implementation of treatment, based on the patient's individual constellation of findings and personal wishes, are prerequisites for therapeutic success. Reconstructive measures, particularly microsurgical ones, have proven their usefulness and are an established component of surgical treatment.
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Affiliation(s)
- Klaus-Dietrich Wolff
- Clinic and Policlinic for Oro-Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany.
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Caputo JB, Campos SS, Pereira SM, Castelo PM, Gavião MBD, Marques LS, Pereira LJ. Masticatory performance and taste perception in patients submitted to cancer treatment. J Oral Rehabil 2012; 39:905-13. [PMID: 22957850 DOI: 10.1111/joor.12005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2012] [Indexed: 12/28/2022]
Abstract
The aim of this study was to analyse mastication and the sense of taste in 39 patients submitted to cancer treatment in different areas of the body and to compare these variables with those of 44 control individuals within the same age range. The following aspects were assessed: dental status (DMFT); stimulated and non-stimulated salivary flow; sense of taste (salty, sweet, bitter and sour); and masticatory performance (MP), through the calculation of X(50). Logistic regression models were established to test the association between the independent variables and cancer treatment. Cancer patients had lesser stimulated salivary flow, a smaller number of teeth and occlusal units, worse MP, higher salty, sweet and sour taste scores and a lower bitter taste score (P < 0·05). A significant positive correlation was found between MP and the DMFT index in both groups (P < 0·05), meaning that a lower DMFT index value denoted a smaller X(50) value (better masticatory performance). The logistic regression model revealed that patients who had undergone cancer treatment had a greater probability of exhibiting a smaller number of teeth, higher salty and smaller bitter taste scores (P < 0·05). It was concluded that patients who were submitted to cancer treatment presented oral physiology alterations when compared with control subjects at the same age range.
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Affiliation(s)
- J B Caputo
- Centro Universitário de Lavras, Lavras, Brazil
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Nakasato T, Izumisawa M, Akahane A, Kikuchi K, Ehara S, Shoji S, Kogi S, Mizuki H, Sugiyama Y. Combined intra-arterial infusion and systemic chemoradiotherapy for stage IV squamous cell carcinoma of the mandibular gingiva. Jpn J Radiol 2012; 30:752-61. [DOI: 10.1007/s11604-012-0122-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 08/10/2012] [Indexed: 11/28/2022]
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28
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Yamauchi T, Edahiro A, Watanabe Y, Murakami M, Satou E, Saito H, Sanjo Y, Sakai K, Takaki S, Kamiyama I, Hanaue N, Satou K, Tonogi M, Katakura A, Shibahara T, Yamane GY. Risk factors for postoperative dysphagia in oral cancer. THE BULLETIN OF TOKYO DENTAL COLLEGE 2012; 53:67-74. [PMID: 22790335 DOI: 10.2209/tdcpublication.53.67] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
With the founding of its Oral Cancer Center at the Ichikawa General Hospital, Tokyo Dental College established a support system for patients and family members that not only provides surgery and other conventional cancer-oriented treatments, but also palliative care, nutritional support, rehabilitation, and discharge support. With this in mind, the present study sought to examine the nature of support for oral cancer patients with postoperative eating and swallowing disorders by investigating these disorders and identifying their risk factors. The study population comprised 75 surviving oral cancer patients (46 men and 29 women) discharged from the Tokyo Dental College Oral Cancer Center following treatment over a 2-year period from April 2009 to March 2011. Risk factors affecting eating and swallowing function were identified by statistical analysis. Mean age of the patients was 67.3±13.7 years. Fifteen patients had stage I cancer, while 25 had stage II, 13 had stage III, and 22 had stage IV. The feeding route at the time of discharge was oral feeding in 74 patients and a combination of oral and gastrostomy tube feeding in 1 patient. The Tokyo Dental College Ichikawa General Hospital has standardized the expert evaluation and rehabilitation of oral cancer patients with eating and swallowing disorders by establishing a multidisciplinary support system from the preoperative stage onwards. In this context, the results of our analysis of factors influencing the ability of oral cancer patients to orally ingest food after treatment suggest that preoperative cancer stage classification, neck dissection, and tracheotomy are all influential factors. Patients affected by these factors require further multidisciplinary treatment, which in turn necessitates more extensive coordination with other medical professionals and community health care providers.
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Affiliation(s)
- Tomohiro Yamauchi
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba 261-8502, Japan.
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Namaki S, Tanaka T, Hara Y, Ohki H, Shinohara M, Yonhehara Y. Videofluorographic evaluation of dysphagia before and after modification of the flap and scar in patients with oral cancer. J Plast Surg Hand Surg 2011; 45:136-42. [PMID: 21682610 DOI: 10.3109/2000656x.2011.569198] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Dysphagia is an important postoperative problem in patients with oral cancer. We evaluated the usefulness of a technique to modify the flap and scar for the alleviation of swallowing disorders. The modifications were made while tongue pressure was being measured to improve excursion of the residual tongue in nine patients. They had been operated on for oral cancer and reconstruction was with a forearm free flap, or the wound was closed primarily. After a 5 ml bolus of liquid barium had been given orally, lingual movement, barium inflow into the pharynx before swallowing, stasis in the epiglottic valleculae, and stasis in the oral cavity after swallowing, were evaluated by videofluorography before and after modification. Oral transit time, pharyngeal transit time, and total transit time were also measured. Lingual movement improved in eight patients. Barium inflow into the pharynx before swallowing improved slightly in all patients. Stasis in the epiglottic valleculae was improved in six patients. Stasis in the oral cavity improved in all patients. Oral transit time and total transit time were significantly shorter after modification of the flap and scar than before operation. Pharyngeal transit time was unchanged. We conclude that our technique for modification of the flap and scar can alleviate postoperative swallowing dysfunction in patients with oral cancer.
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Affiliation(s)
- Shunsuke Namaki
- 2nd Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan.
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Anne-Gaëlle B, Samuel S, Julie B, Renaud L, Pierre B. Dental implant placement after mandibular reconstruction by microvascular free fibula flap: current knowledge and remaining questions. Oral Oncol 2011; 47:1099-104. [PMID: 21873106 DOI: 10.1016/j.oraloncology.2011.07.016] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 07/12/2011] [Accepted: 07/20/2011] [Indexed: 11/28/2022]
Abstract
Mandibular reconstruction by microvascular free fibula flap has dramatically improved the quality of life of patients treated by interruptive surgery. A simple prosthesis can be used for dental rehabilitation but in many cases, these prostheses remain nonfunctional. The use of osseointegrated implants restores both function and aesthetics. The technique for implantation in fibula flap is very similar to the technique in native mandible but access to the bone is the most difficult step of the surgery. The success rate for osteointegration ranges from 86% to 99% but the success rate of the prosthesis is much lower. This difference could be explained by the vertical discrepancy between the graft and the remaining mandible, which leads to an unfavourable implant-crown ratio. The quality of soft tissues is also a limiting factor for the prosthesis, and hypertrophy often appears after the placement of the abutments. The type of the prosthesis (fixed or removable) should also be discussed. Occlusal considerations should be highlighted as occlusion remains abnormal in many cases. Three-dimensional imaging might help in the planning of these complex reconstructions. A close collaboration between the maxillo-facial surgeon, the oral surgeon and the prosthodontist is necessary to obtain good results.
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Affiliation(s)
- Bodard Anne-Gaëlle
- Surgery Department, Centre Léon Bérard, 28 rue Laennec, 69373 Lyon cedex 08, France.
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Loewen IJ, Boliek CA, Harris J, Seikaly H, Rieger JM. Oral sensation and function: a comparison of patients with innervated radial forearm free flap reconstruction to healthy matched controls. Head Neck 2010; 32:85-95. [PMID: 19536773 DOI: 10.1002/hed.21155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Limited evidence exists for the use of innervated radial forearm free flap (RFFF) reconstruction of hemiglossectomy defects. This study reports on sensation, mastication, and speech outcomes for patients with innervated RFFF reconstruction of the anterior two-thirds of the tongue. METHODS Sensation, mastication, and speech intelligibility were assessed in 8 patients and age- and sex-matched controls. RESULTS Sensation of intact tongue tissue after reconstruction of the hemitongue did not differ from controls. Although some sensory ability was restored to patients' reconstructed tongue, differences existed between the patient group and controls. However, whole mouth sensations resulted in similar sensory ability as controls. Whereas patients demonstrated adequate masticatory and speech ability, differences existed between patients and controls. CONCLUSION Although some sensory ability is preserved in patients who have had tongue reconstruction with an innervated RFFF, functional outcomes such as masticatory ability and speech intelligibility may be affected in some patients.
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Affiliation(s)
- Irene J Loewen
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Alberta, Canada.
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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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Speksnijder CM, Abbink JH, van der Glas HW, Janssen NG, van der Bilt A. Mixing ability test compared with a comminution test in persons with normal and compromised masticatory performance. Eur J Oral Sci 2009; 117:580-6. [DOI: 10.1111/j.1600-0722.2009.00675.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Investigation of predictors affecting food mixing ability in mandibulectomy and/or glossectomy patients. J Prosthodont Res 2009; 53:111-5. [DOI: 10.1016/j.jpor.2009.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 11/30/2008] [Indexed: 11/24/2022]
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Jegoux F, Bedfert C, Alno N, Godey B, Le Clech G. [Mandibular involvement and resection in management of oral carcinomas]. ACTA ACUST UNITED AC 2009; 126:149-54. [PMID: 19473650 DOI: 10.1016/j.aorl.2009.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 04/26/2009] [Indexed: 11/15/2022]
Affiliation(s)
- F Jegoux
- Service d'ORL et chirurgie maxillo-faciale, CHU Pontchaillou, rue Henri-Le-Guillou, 35033 Rennes cedex 9, France.
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Marginal mandibulectomy: 11 years of institutional experience. J Oral Maxillofac Surg 2009; 67:962-7. [PMID: 19375004 DOI: 10.1016/j.joms.2008.08.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 06/24/2008] [Accepted: 08/20/2008] [Indexed: 11/20/2022]
Abstract
PURPOSE Literature on marginal mandibulectomy deals mainly with floor of mouth cancers. The purpose of the present study was to evaluate the oncologic outcome of marginal mandibulectomy in buccal sulcus cancer as compared with floor of mouth cancer. PATIENTS AND METHODS Chart review of 179 patients who underwent marginal mandibulectomy during 1993 to 2003 at Tata Memorial Hospital yielded 161 marginal mandibulectomies done for squamous cell carcinoma (SCC). Oncologic outcomes in terms of disease control and cause-specific survival for the gingival buccal and tongue/floor of mouth cancers were compared. Independent impact of various prognostic factors on the local control and cause-specific survival was evaluated using Cox proportional hazards model. RESULTS A total of 137 marginal mandibulectomies were done for SCC in gingival buccal complex and 24 for floor of mouth SCC. Bone was microscopically involved in 13 (8.1%) cases and mucosal margin of excision showed tumor in 12 (7.5%) cases. However, they had no influence on locoregional failure or cause-specific survival. Cause-specific survival at 2 and 5 years was 85.6% and 72.2%, respectively. Cause-specific survival at 5 years was significantly better for buccal cancer than floor of mouth cancer (P = .041). On multivariate analysis patients with floor of mouth cancer were at a 3 times higher risk of dying of disease than those with buccal cancer. CONCLUSION In carefully selected patients, marginal mandibulectomy in buccal sulcus cancer achieves at least as good local control and survival as compared with the floor of mouth cancer.
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Van Cann E, Koole R, Oyen W, de Rooy J, de Wilde P, Slootweg P, Schipper M, Merkx M, Stoelinga P. Assessment of mandibular invasion of squamous cell carcinoma by various modes of imaging: constructing a diagnostic algorithm. Int J Oral Maxillofac Surg 2008; 37:535-41. [DOI: 10.1016/j.ijom.2008.02.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 01/07/2008] [Accepted: 02/28/2008] [Indexed: 10/22/2022]
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Van Cann EM, Rijpkema M, Heerschap A, van der Bilt A, Koole R, Stoelinga PJW. Quantitative dynamic contrast-enhanced MRI for the assessment of mandibular invasion by squamous cell carcinoma. Oral Oncol 2008; 44:1147-54. [PMID: 18485797 DOI: 10.1016/j.oraloncology.2008.02.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 02/22/2008] [Accepted: 02/22/2008] [Indexed: 11/16/2022]
Abstract
The objective of this study was to determine the value of dynamic contrast-enhanced MRI (DCE-MRI) for the preoperative assessment of mandibular invasion in squamous cell carcinomas (SCC), adjacent or fixed to the mandible. DCE-MRI was performed with gadolinium diethylene triamine pentaacetic acid (Gd-DTPA). Data were obtained from 25 patients. From pharmacokinetic analysis of the tissue uptake of Gd-DTPA, the DCE-MRI parameters (k(ep), K(trans) and v(e)) were determined, with k(ep) representing the exchange rate constant, K(trans) the volume transfer constant and v(e) the volume of extracellular space per unit volume of tissue. The histology of the resection specimens was used as gold standard for the extent of mandibular invasion. SCC with medullary invasion showed higher mean k(ep) and K(trans) compared with SCC without medullary invasion (ANOVA, p<0.001). ROC analysis of k(ep) and K(trans) revealed reliable threshold values for medullary invasion. In conclusion, DCE-MRI can discriminate SCC with medullary invasion from SCC without medullary invasion and may serve as a valuable tool in preoperative tumour staging with regard to the delineation of medullary invasion.
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Affiliation(s)
- Ellen M Van Cann
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Rogers SN, Ahad SA, Murphy AP. A structured review and theme analysis of papers published on ‘quality of life’ in head and neck cancer: 2000–2005. Oral Oncol 2007; 43:843-68. [PMID: 17600755 DOI: 10.1016/j.oraloncology.2007.02.006] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2006] [Revised: 02/25/2007] [Accepted: 02/26/2007] [Indexed: 11/18/2022]
Abstract
Over the past 10 years, quality of life (QOL) has been increasingly recognised as an important outcome parameter in head and neck cancer. Validated questionnaires have emerged and there has been an increase in the number of papers published each year. The aim of this article is to review the literature over the past five years (2000-2005 inclusive), to identify papers reporting outcomes using patient self-competed questionnaires and group these into themes. The tabulated summary allows for the areas of health related quality of life research to be identified and to explore issues that are perhaps deficit in the literature. The three authors independently searched the literature published in the English language using the ISI search engine with cross-reference using Pub Med and Ovid. The search terms were; quality of life, questionnaire, and head and neck cancer. Studies were placed in to one of five themes. There were 165 studies identified. The numbers in each theme were predictors of QOL [Hassanein KA, Musgrove BT, Bradbury E. Functional status of patients with oral cancer and its relation to style of coping, social support and psychological status. Br J Oral Maxillofac Surg 2001;39:340-5.], functional outcome [Klug C, Neuburg J, Glaser C, Schwarz B, Kermer C, Millesi W. Quality of life 2-10 years after combined treatment for advanced oral and oropharyngeal cancer. Int J Oral Maxillofac Surg 2002;31:664-9.], questionnaire development [Hanna E, Sherman A, Cash D, Adams D, Vural E, Fan CY, et al. Quality of life for patients following total laryngectomy vs chemoradiation for laryngeal preservation. Arch Otolaryngol Head Neck Surg 2004;130:875-9.], randomised clinical trials [Kanatas AN, Rogers SN. A national survey of health-related quality of life questionnaires in head and neck oncology. Ann R Coll Surg Engl 2004;86:6-10.], and reviews [Kanatas AN, Rogers SN. A national survey of health-related quality of life questionnaires in head and neck oncology. Ann R Coll Surg Engl 2004;86:6-10.]. Although many facets of HRQOL following head and neck cancer have been explored over the last five years the paper identifies issues where research is still lacking.
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Affiliation(s)
- S N Rogers
- Regional Maxillofacial Unit, University Hospital Aintree, Aintree Trust, Liverpool L9 7AL, UK.
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40
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Hirsch DL, Dierks EJ. Use of a Transbuccal Technique for Marginal Mandibulectomy: A Novel Approach. J Oral Maxillofac Surg 2007; 65:1849-51. [PMID: 17719411 DOI: 10.1016/j.joms.2005.10.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2005] [Accepted: 10/27/2005] [Indexed: 11/27/2022]
Affiliation(s)
- David L Hirsch
- Head and Neck Surgical Associates, Legacy Emanuel Hospital, Portland, OR, USA.
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Genden EM, Rinaldo A, Jacobson A, Shaha AR, Suárez C, Lowry J, Urquhart AC, Werner JA, Gullane PJ, Ferlito A. Management of mandibular invasion: When is a marginal mandibulectomy appropriate? Oral Oncol 2005; 41:776-82. [PMID: 16109354 DOI: 10.1016/j.oraloncology.2004.12.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 12/06/2004] [Indexed: 11/30/2022]
Abstract
There has been a great deal of controversy regarding the appropriate method of management of oral cavity and oropharyngeal tumors that invade the mandible. The inability to acquire intraoperative bone margins can make the decision process complex. Preoperative imaging offers several advantages, however, there is no single modality that has proven accurate. Intraoperative assessment has been suggested as a method of evaluation, however, this approach does not allow for preoperative planning. The following is a review of the current literature regarding mandibular invasion and the indications for a marginal mandibulectomy.
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Affiliation(s)
- Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY, USA
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