RESUMO
BACKGROUND: Limitation of mouth opening, widely known as trismus, is a major symptom altering quality of life in individuals presenting from temporomandibular joint disorder or head and neck cancer. A French-language instrument addressing jaw opening limitation following treatment for head and neck cancer (HNC) or temporomandibular joint disorder (TMD) is lacking. OBJECTIVE: The aim of this study was to translate and validate the Gothenburg Trismus Questionnaire-2 (GTQ-2) into French. METHODS: A French translation of the GTQ-2 was performed according to established international guidelines, leading to the French-GTQ-2 (F-GTQ-2). The validation study included 154 participants with trismus (minimum interincisal opening of ≤35 mm) following treatment for TMD or HNC and 149 age-matched participants without trismus. All participants completed the F-GTQ-2 and participants with trismus completed additional health-related quality of life questionnaires to allow for analysis of convergent validity. RESULTS: The F-GTQ-2 demonstrated retained psychometric properties with Cronbach's alpha values above 0.70 for the domains, jaw-related problems, eating limitations, facial pain and somewhat lower for muscular tension (0.60). Mainly moderate correlations were found when comparing the F-GTQ-2 to other instruments, which was in line with the pre-specified hypotheses, indicating satisfactory convergent validity. Discriminant validity was found with statistically significant differences in all domains of the F-GTQ-2 between trismus and non-trismus participants. CONCLUSION: The F-GTQ-2 can be considered a reliable and valid instrument to assess jaw-related difficulties in individuals with trismus due to HNC or TMD.
Assuntos
Neoplasias de Cabeça e Pescoço , Psicometria , Qualidade de Vida , Traduções , Trismo , Humanos , Trismo/fisiopatologia , Feminino , Masculino , Inquéritos e Questionários/normas , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/psicologia , Neoplasias de Cabeça e Pescoço/fisiopatologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/psicologia , Transtornos da Articulação Temporomandibular/complicações , Idoso , França , Dor Facial/fisiopatologiaRESUMO
This study aimed to update and, if necessary, revise the Gothenburg Trismus Questionnaire (GTQ), the only existing trismus-specific questionnaire, and retest its psychometric properties. Semi-structured interviews were performed with 10 trismus patients of which 5 had head and neck cancer (HNC) and 5 suffered from benign temporomandibular disorders. Trismus was defined as a maximal incisal opening of ≤ 35mm. An expert panel discussed and revised the GTQ based on interview information, expertise knowledge and the original questionnaire. The revised questionnaire was then tested in a study sample consisting of benign jaw-related conditions (n = 26), patients treated for HNC (n = 90) and an age- and gender-matched control group with no trismus (n = 116). The revised version of the GTQ (GTQ 2) was well accepted by patients. The original three domains continued to show high internal consistency (Cronbach's alpha 0.74-0.94) and construct validity. Two dually posed single items were split into four questions and the wording was altered in another three items. Moreover, a new domain (Facial pain) was identified, which had excellent internal consistency (α = 0.96) and good construct validity. The revision of the original Gothenburg Trismus Questionnaire (GTQ 1) with inclusion of patient-input, resulted in splitting of ambiguous items, identifying a fourth domain named Facial pain and the recall time shortened for some items. Additionally, the remaining domains and items were re-confirmed as strong in the psychometric analysis. Henceforth, the new version, GTQ 2 should be used.
Assuntos
Psicometria/métodos , Inquéritos e Questionários , Trismo/diagnóstico , Adulto , Idoso , Cognição , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Trismo/complicações , Trismo/fisiopatologia , Adulto JovemAssuntos
Condrocalcinose/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Doença Aguda , Idoso de 80 Anos ou mais , Artralgia/fisiopatologia , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Condrocalcinose/metabolismo , Condrocalcinose/patologia , Condrocalcinose/fisiopatologia , Feminino , Febre/fisiopatologia , Humanos , Cervicalgia/fisiopatologia , Transtornos da Articulação Temporomandibular/metabolismo , Transtornos da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Tomografia Computadorizada por Raios X , Trismo/fisiopatologiaAssuntos
Músculos Faciais/fisiopatologia , Debilidade Muscular/diagnóstico , Tétano/diagnóstico , Trismo/diagnóstico , Antibacterianos/uso terapêutico , Paralisia de Bell/diagnóstico , Desbridamento , Diagnóstico Diferencial , Traumatismos Faciais/complicações , Traumatismos Faciais/terapia , Feminino , Humanos , Imunoglobulinas/uso terapêutico , Lacerações/complicações , Lacerações/terapia , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Tétano/etiologia , Tétano/fisiopatologia , Tétano/terapia , Toxoide Tetânico/uso terapêutico , Trismo/etiologia , Trismo/fisiopatologiaRESUMO
BACKGROUND: The aim of this study was to investigate how common temporomandibular disorder (TMD) symptoms are among head and neck cancer (HNC) patients before and after oncological treatment. METHODS: Eighty-nine patients with HNC receiving radiotherapy were enrolled in the study. Patients were examined before radiotherapy and at 6 and 12 months after radiotherapy to evaluate the function and tenderness of the temporomandibular jaw and the muscles of mastication as well as the patient-reported symptoms. RESULTS: At 6 months after radiotherapy, there was a large increase in the number of patients reporting problems with opening their mouth, fatigue, stiffness, and pain of the jaw. Sixty-eight percent of the patients had symptoms of TMD before oncological treatment and 94% and 81% had symptoms at the 6- and 12-month follow-up, respectively. CONCLUSION: The signs and symptoms of TMD escalate after radiotherapy, with symptoms peaking at 6 months after radiotherapy. Most commonly, patients suffer from restricted mouth opening, stiffness, fatigue, and pain of the jaw.
Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Medidas de Resultados Relatados pelo Paciente , Radioterapia de Alta Energia/efeitos adversos , Transtornos da Articulação Temporomandibular/etiologia , Trismo/etiologia , Idoso , Carcinoma de Células Escamosas/patologia , Estudos de Coortes , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Radioterapia de Alta Energia/métodos , Estudos Retrospectivos , Medição de Risco , Transtornos da Articulação Temporomandibular/fisiopatologia , Fatores de Tempo , Trismo/fisiopatologiaRESUMO
Background and objectives: Due to the fact that the mandible is the only movable bone in the face, it is often exposed to the influence of external forces. The incidence of trismus and posttraumatic pain in unilateral mandibular corpus fractures may be related to the occurrence of complications. There is a decrease in the quality of life of these patients. The aim was to study the relationship of the preoperative pain and trismus with the incidence of complications, as well as to investigate the quality of life. Materials and Methods: A prospective study on 60 patients with isolated mandibular fractures was performed, with a follow-up period of six months. The level of preoperative pain was measured on a 0-10 scale, while the mouth opening was measured with a caliper. All patients were treated surgically on the third day after the fracture. The University of Washington Quality of Life (UW-QOL v4) questionnaire was used to analyze the quality of life. Results: The most common types of complications were the occlusal derangement and facial asymmetry. The majority of complications were treated with counseling and physical therapy. The degree of preoperative pain was significantly positively related to the onset of complications (rs = 0.782, p = 0.004). The interincisal distance showed a significant inverse relation with the incidence of complications (rs = -0.722, p < 0.001). The patients regarded the pain, appearance and mood issues as the most important issues during the first postoperative month. Conclusions: The degree of inflammatory symptoms may be positively related to the onset of complications occurring after the rigid fixation of mandibular fractures. The postoperative health-related and overall quality of life was unsatisfactory in nearly half of the patients.
Assuntos
Fixação Interna de Fraturas/efeitos adversos , Fraturas Mandibulares/cirurgia , Dor Pós-Operatória/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Trismo/fisiopatologia , Adulto , Idoso , Assimetria Facial/etiologia , Feminino , Seguimentos , Humanos , Masculino , Mastigação , Pessoa de Meia-Idade , Montenegro , Dor Pós-Operatória/reabilitação , Período Pós-Operatório , Estudos Prospectivos , Sistemas de Apoio Psicossocial , Qualidade de Vida , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: Hemimasticatory spasm (HMS) is a rare masticatory muscle disorder. Drug therapy, microvascular decompression, and botulinum toxin have had varying efficacy and adverse effects. We have reported the cases of 2 patients who had undergone a novel therapy for HMS, based on endoscope-assisted nerve avulsion of the masseter nerve attached to the temporomandibular joint (TMJ) disc. METHODS: We performed a retrospective study of 2 patients with HMS who had undergone surgery from June 2014 to June 2017 at the oral surgery department of Shanghai Ninth People's Hospital affiliated to Shanghai JiaoTong University School of Medicine. Both patients had undergone endoscope-assisted avulsion of the masseter nerve attached to the TMJ disc. Both patients were evaluated by electromyography postoperatively and were followed up for 36 months after surgery. RESULTS: Both patients had had all the signs and symptoms of HMS. The HMS had resolved immediately after surgery. At 1 week after surgery, electromyography revealed that the high-frequency group discharge potential in the motor unit accompanying the spasm was no longer present, and the effect was maintained for the 36-month follow-up period. These results indicated a good curative effect. Electromyography also showed strength weakness and mild shape atrophy of the masseter muscle on the affected side. CONCLUSIONS: Endoscope-assisted avulsion of the masseter nerve attached to the TMJ disc showed a good curative effect, little trauma, few complications, and a quick postoperative recovery. It could be used as an alternative treatment of HMS for selected patients.
Assuntos
Músculo Masseter/cirurgia , Neuroendoscopia/métodos , Trismo/cirurgia , Adulto , Eletromiografia , Feminino , Humanos , Masculino , Músculo Masseter/inervação , Músculo Masseter/fisiologia , Pessoa de Meia-Idade , Trismo/fisiopatologiaRESUMO
BACKGROUND: We studied the relationship between trismus (maximum interincisor opening [MIO] ≤35 mm) and the dose to the ipsilateral masseter muscle (iMM) and ipsilateral medial pterygoid muscle (iMPM). METHODS: Pretreatment and post-treatment measurement of MIO at 13 weeks revealed 17% of trismus cases in 83 patients treated with chemoradiation and intensity-modulated radiation therapy. Logistic regression models were fitted with dose parameters of the iMM and iMPM and baseline MIO (bMIO). A risk classification tree was generated to obtain optimal cut-off values and risk groups. RESULTS: Dose levels of iMM and iMPM were highly correlated due to proximity. Both iMPM and iMM dose parameters were predictive for trismus, especially mean dose and intermediate dose volume parameters. Adding bMIO, significantly improved Normal Tissue Complication Probability (NTCP) models. Optimal cutoffs were 58 Gy (mean dose iMPM), 22 Gy (mean dose iMM) and 46 mm (bMIO). CONCLUSIONS: Both iMPM and iMM doses, as well as bMIO, are clinically relevant parameters for trismus prediction.
Assuntos
Quimiorradioterapia/efeitos adversos , Neoplasias de Cabeça e Pescoço/terapia , Radioterapia de Intensidade Modulada/efeitos adversos , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia , Trismo/etiologia , Adulto , Idoso , Quimiorradioterapia/métodos , Bases de Dados Factuais , Relação Dose-Resposta à Radiação , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Músculo Masseter/efeitos da radiação , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Países Baixos , Valor Preditivo dos Testes , Prognóstico , Músculos Pterigoides/efeitos da radiação , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos , Medição de Risco , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Resultado do Tratamento , Trismo/fisiopatologiaAssuntos
Clobazam/uso terapêutico , Distonia/fisiopatologia , Lorazepam/administração & dosagem , Doenças Mandibulares/fisiopatologia , Músculos da Mastigação/fisiopatologia , Fármacos Neuromusculares/administração & dosagem , Trismo/etiologia , Pré-Escolar , Distonia/complicações , Distonia/tratamento farmacológico , Feminino , Humanos , Doenças Mandibulares/complicações , Doenças Mandibulares/tratamento farmacológico , Músculos da Mastigação/efeitos dos fármacos , Resultado do Tratamento , Trismo/fisiopatologiaRESUMO
Purpose Assess the effectiveness of an orofacial myofunctional therapeutic program in patients with oral or oropharyngeal cancer submitted to adjuvant radiotherapy through pre- and post-program comparison of maximum mandibular opening. Methods Prospective study involving five adult patients and five elderly patients postoperatively to oral cavity/oropharynx surgery who were awaiting the beginning of radiotherapy or had undergone fewer than five treatment sessions. The study participants had their maximum jaw opening measured using a sliding caliper at the beginning and end of the program. Two mobility exercises and three mandibular traction exercises were selected and weekly monitored presentially for 10 weeks. Descriptive data and pre- and post-therapy comparative measures were statistically analyzed using the Wilcoxon test. Results Ten patients (two women and eight men) with mean age of 58.4 years, median of 57.0 years, completed the therapeutic program. They presented mean maximum mandibular opening of 31.6 ± 11.7 and 36.4 ± 8.0 mm pre- and post-therapy, respectively (p =0.021). Conclusion The proposed orofacial myofunctional therapeutic program increased the maximum jaw opening of patients referred to adjuvant radiotherapy for oral cavity or oropharynx cancer treatment.
Assuntos
Terapia Miofuncional/métodos , Neoplasias Orofaríngeas/radioterapia , Lesões por Radiação/reabilitação , Fonoterapia/métodos , Trismo/reabilitação , Adulto , Idoso , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Boca/fisiopatologia , Boca/efeitos da radiação , Neoplasias Orofaríngeas/fisiopatologia , Projetos Piloto , Estudos Prospectivos , Lesões por Radiação/fisiopatologia , Radioterapia Adjuvante/efeitos adversos , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Resultado do Tratamento , Trismo/etiologia , Trismo/fisiopatologiaRESUMO
BACKGROUND: Trismus can be a challenging consequence of ballistic trauma to the face, and has rarely been described in the setting of face transplantation. Almost half of all current face transplant recipients in the world received transplantation to restore form and function after a ballistic injury. Here we report our experience and challenges with long standing trismus after face transplantation. METHODS: We reviewed the medical records of our face transplant recipients whose indication was ballistic injury. We focused our review on trismus and assessed the pre-, peri- and postoperative planning, surgery and functional outcomes. RESULTS: Two patients received partial face transplantation, including the midface for ballistic trauma. Both patients suffered from impaired mouth opening, speech intelligibility, and oral competence. Severe scarring of the temporomandibular joint (TMJ) required intraoperative release in both patients, and additional total condylectomy on the left side 6 months posttransplant for 1 patient. Posttransplant, both patients achieved an improvement in mouth opening; however, there was persistent trismus. One year after transplantation, range of motion of the jaw had improved for both patients. Independent oral food intake was possible 1 year after surgery, although spillage of liquids and mixed consistency solids persisted. Speech intelligibility testing showed impairments in the immediate postoperative period, with improvement to over 85% for both patients at 1 year posttransplant. CONCLUSIONS: Ballistic trauma to the face and subsequent reconstructive measures can cause significant scarring and covert injuries to structures such as the TMJ, resulting in long standing trismus. Meticulous individual planning prior to interventions such as face transplantation must take these into account. We encourage intraoperative evaluation of these structures as well as peri- and postoperative treatment when necessary. Due to the nature of the primary injury, functional outcomes after face transplantation in these patients may differ substantially from those of other indications.
Assuntos
Transplante de Face/efeitos adversos , Procedimentos de Cirurgia Plástica , Complicações Pós-Operatórias , Trismo , Adulto , Face/fisiopatologia , Face/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Amplitude de Movimento Articular , Trismo/etiologia , Trismo/fisiopatologia , Trismo/cirurgia , Ferimentos por Arma de FogoRESUMO
BACKGROUND: Trismus is a common complication of radiotherapy for head and neck cancer but its impact on survival is unknown. AIMS/OBJECTIVES: This prospective study evaluates the incidence of trismus in patients with head and neck cancer receiving radiotherapy and the impact of trismus on 5-year overall survival. MATERIAL AND METHODS: Two hundred forty-four patients with head and neck cancer were included. All patients received instructions on jaw exercises and were evaluated before initiation of radiotherapy and at 2, 6, and 12 months after termination of radiotherapy. RESULTS: One year after treatment 25% had a reduced maximum interincisal opening (MIO) of 13 mm or more as compared to the pretreatment MIO. Trismus was most prevalent in patients with oral and oropharyngeal cancer. A trend towards worse 5-year overall survival was seen among patients with trismus. CONCLUSIONS: The trismus rate was approximately 30% at 12 months. Jaw exercises should primarily be offered to patients with oral and oropharyngeal cancer who are most likely to benefit. Further studies are required to investigate the effect of trismus on survival. SIGNIFICANCE: This study identifies patients likely to benefit from jaw exercises and provides basis for further research on trismus and survival.
Assuntos
Causas de Morte , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Orofaríngeas/mortalidade , Neoplasias Orofaríngeas/radioterapia , Radioterapia Conformacional/efeitos adversos , Trismo/etiologia , Idoso , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/patologia , Neoplasias Orofaríngeas/cirurgia , Estudos Prospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Fatores de Tempo , Trismo/mortalidade , Trismo/fisiopatologiaRESUMO
BACKGROUND: Masseter hypertrophy is a common, prominent feature in many Asian patients, and correction procedures are often requested for esthetic reasons. Toxin masseter injections have a high efficacy and safety profile, but the risks of a variety of side effects or complications remain. OBJECTIVES: The categorization of various complications was based on etiology, with a presentation of the author's own incidence rates for consideration and comparison. METHODS: Six hundred and eighty patients received a total of 2036 sessions of toxin injection for masseter hypertrophy from 2011 to 2016, and complications or complaints were recorded through follow-up on a by-treatment basis. Complications were grouped together based on etiology and discussed. RESULTS: Of 2036 sessions, temporary mastication force decrease was reported after 611 (30%), bruising after 51 (2.5%), headaches after 12 (0.58%), smile limitation after 3 (0.15%), paradoxical bulging after 10 (0.49%), sunken cheeks (subzygomatic volume loss) after 9 (0.44%), and sagging after 4 (0.20%). CONCLUSIONS: Masseter injections remain very safe. To further decrease the incidence rate, injections should only be inside the recommended safety zone, a quadrilateral within the muscle that avoids most important local structures. Keeping injections inside the safe zone, and ideally in 3-4 different locations at least 1 cm from any border, is crucial for the prevention of complications.
Assuntos
Toxinas Botulínicas Tipo A/efeitos adversos , Músculo Masseter/efeitos dos fármacos , Músculo Masseter/patologia , Trismo/induzido quimicamente , Xerostomia/induzido quimicamente , Adulto , Toxinas Botulínicas Tipo A/administração & dosagem , Estudos de Coortes , Paralisia Facial/induzido quimicamente , Paralisia Facial/fisiopatologia , Feminino , Seguimentos , Cefaleia/induzido quimicamente , Cefaleia/fisiopatologia , Humanos , Hipertrofia/patologia , Injeções Intramusculares , Masculino , Músculo Masseter/anormalidades , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Trismo/fisiopatologia , Xerostomia/fisiopatologiaRESUMO
BACKGROUND: The main clinical application of electromyography is to detect abnormalities in muscle function, to assess muscle activity for purposes of recruitment, and in the biomechanics of movement. OBJECTIVES: To analyze electromyography (EMG) findings for masticatory muscles during chewing following surgical extraction of lower third molars, and to determine any correlation between pain, inflammation, trismus, and the EMG data registered. MATERIAL AND METHODS: This prospective study included 31 patients. Surface EMG was used to study masseter and temporalis muscle function before lower third molar extraction and 72 hours and seven days after surgery. Clinical variables, pain, inflammation, and trismus were registered before and after surgery. RESULTS: Studying the area and size of the masticatory muscles, higher values were found for temporalis than masseter muscles, regardless of the surgical side, which points to the greater involvement of the temporalis muscle in mastication. Comparing the side where surgery had been performed with the non-surgical side, a sharp and statistically significant reduction in amplitude and area were noted on the surgical side reflecting major functional affectation. One week after surgery, amplitude and area had almost returned to base-line values, indicating almost complete recovery. While pain decreased progressively after surgery, inflammation peaked at 72 hours, while mouth opening reached a minimum at this time, returning to normality within the week. CONCLUSIONS: Surgical extraction of lower third molars produces changes to electromyography activity that are more evident during the first hours after surgery and closely related to the intensity of pain suffered and the patient's inflammatory responses, although they are not related to mouth opening capacity.
Assuntos
Eletromiografia , Músculo Masseter/fisiologia , Dente Serotino/cirurgia , Músculo Temporal/fisiologia , Extração Dentária , Feminino , Humanos , Inflamação/diagnóstico , Inflamação/fisiopatologia , Estudos Longitudinais , Masculino , Mandíbula , Mastigação , Dor/fisiopatologia , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Cuidados Pré-Operatórios , Estudos Prospectivos , Trismo/diagnóstico , Trismo/fisiopatologia , Adulto JovemRESUMO
RESUMO Objetivo Analisar, por meio da comparação entre a abertura máxima mandibular, a efetividade de programa terapêutico miofuncional oral em pacientes com câncer de boca ou orofaringe submetidos à radioterapia adjuvante. Método Estudo prospectivo envolvendo cinco pacientes adultos e cinco idosos em pós-operatório de cirurgia de boca/orofaringe que aguardavam início da radioterapia ou até a quinta sessão. No início e no final do programa, os participantes tiveram suas medidas de abertura máxima mandibular mensuradas por meio de paquímetro e foram selecionados cinco exercícios - dois de mobilidade e três de tração mandibular - com controle presencial durante oito semanas, perfazendo um total de dez semanas. Dados descritivos e a comparação das medidas pré e pós-fonoterapia por meio do teste de Wilcoxon foram considerados na análise dos dados. Resultados Dez pacientes finalizaram o programa terapêutico (duas mulheres e oito homens), com média de idade de 58,4 anos, mediana de 57,0 anos. Apresentaram média de abertura máxima mandibular de 31,6 ± 11,7 mm antes do tratamento e 36,4 ± 8,0 mm no pós-terapia (p=0,021). Conclusão O programa terapêutico miofuncional oral proposto promoveu aumento da abertura máxima vertical da mandíbula de pacientes submetidos à radioterapia e/ou quimioterapia adjuvante para tratamento de câncer de boca e orofaringe.
ABSTRACT Purpose Assess the effectiveness of an orofacial myofunctional therapeutic program in patients with oral or oropharyngeal cancer submitted to adjuvant radiotherapy through pre- and post-program comparison of maximum mandibular opening. Methods Prospective study involving five adult patients and five elderly patients postoperatively to oral cavity/oropharynx surgery who were awaiting the beginning of radiotherapy or had undergone fewer than five treatment sessions. The study participants had their maximum jaw opening measured using a sliding caliper at the beginning and end of the program. Two mobility exercises and three mandibular traction exercises were selected and weekly monitored presentially for 10 weeks. Descriptive data and pre- and post-therapy comparative measures were statistically analyzed using the Wilcoxon test. Results Ten patients (two women and eight men) with mean age of 58.4 years, median of 57.0 years, completed the therapeutic program. They presented mean maximum mandibular opening of 31.6 ± 11.7 and 36.4 ± 8.0 mm pre- and post-therapy, respectively (p =0.021). Conclusion The proposed orofacial myofunctional therapeutic program increased the maximum jaw opening of patients referred to adjuvant radiotherapy for oral cavity or oropharynx cancer treatment.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Lesões por Radiação/reabilitação , Trismo/reabilitação , Neoplasias Orofaríngeas/radioterapia , Estatísticas não Paramétricas , Terapia Miofuncional/métodos , Lesões por Radiação/fisiopatologia , Fonoterapia/métodos , Trismo/etiologia , Trismo/fisiopatologia , Neoplasias Orofaríngeas/fisiopatologia , Projetos Piloto , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do Tratamento , Terapia por Exercício/métodos , Pessoa de Meia-Idade , Boca/efeitos da radiação , Boca/fisiopatologiaRESUMO
Cold-induced sweating syndrome (CISS) is a rare autosomal recessive disease due to mutation in the Cytokine receptor-like factor 1 (CRLF1). The characteristic symptom of CISS is the tendency to sweat profusely especially in the upper body and hands when the patient is exposed to cold temperature. We sought to first report the findings of autonomic reflex screen in a case of CISS type 1 with Cytokine receptor-like factor 1 mutation. Valsalva morphology, Valsalva ratio, and heart rate response to deep breathing were normal for the patient's age. Quantitative sudomotor axon reflex test showed nonlength dependent decrease in the sweat volume. Tilt table revealed evidence of reflex (vasovagal) "syncope," however, the patient was asymptomatic without loss of consciousness.
Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Deformidades Congênitas da Mão/diagnóstico , Deformidades Congênitas da Mão/fisiopatologia , Hiperidrose/diagnóstico , Hiperidrose/fisiopatologia , Reflexo/fisiologia , Trismo/congênito , Clonidina/uso terapêutico , Morte Súbita , Fácies , Deformidades Congênitas da Mão/tratamento farmacológico , Frequência Cardíaca/fisiologia , Humanos , Hiperidrose/tratamento farmacológico , Masculino , Condução Nervosa/fisiologia , Simpatolíticos/uso terapêutico , Trismo/diagnóstico , Trismo/tratamento farmacológico , Trismo/fisiopatologia , Manobra de Valsalva/fisiologia , Adulto JovemRESUMO
The zygomatico-maxillary complex functions as the principle buttress of the face and is the cornerstone to an individuals aesthetic appearance. Its fracture not only creates cosmetic deformities owing to its position and facial contour, but can also cause disruption of ocular and mandibular functions. The aim of this study was to evaluate the quality, efficacy and impact of internal fixation of zygomatic complex fractures on functional and cosmetic outcomes. A prospective study was carried out on 100 patients who were divided according to the classification and the severity of injury. Subjective evaluation was submitted based on the patients perception of signs and symptoms in the preoperative and postoperative periods. Intraoperative and postoperative assessment of bone reduction quality was made according to the type of the fracture and related difficulties; also, the difference between these groups was observed as functional and esthetic outcome. To optimize the treatment of zygomatic bone fractures, a pre-designed questionnaire was used for subjective evaluation of symptoms and treatment outcome. In 70% of cases, ophthalmologic consultation was taken and was most common in type VII fractures (100% cases). Neurosensory disturbance was the most common finding (60%), followed by diplopia (56R%), pain upon mouth opening (54%) and malar depression (50%). Out of all possible 400 fracture sites in 100 patients of zygomatic complex fractures, 266 (66.5%) fractures were detected by clinical examination, in contrast to 330 (82.5%) on radiological examination, which were highest at zygomatic-maxillary buttress (93%) followed by infraorbital rim (91%) and almost equal among fronto-zygomatic site (72%) and zygomatic arch (74%). The scores from the questionnaire for annoyance were significantly higher for paraesthesia (23%) than for trismus (10%), pain (8.5%), or deformity (8.25%). Residual deformity and pain significantly influenced the total satisfaction. Conclusively, there are many treatment modalities available for zygomatic complex fractures, and the preferred methods should be selected on the basis of fracture type, fracture severity, pre-operative signs and symptoms. Regarding the requirements of fracture site exposure and actual fixation, one priority should be to minimize postoperative complications, morbidity and residual deformities.
Assuntos
Fixação Interna de Fraturas/métodos , Complicações Pós-Operatórias/fisiopatologia , Cirurgia Plástica/métodos , Zigoma/cirurgia , Fraturas Zigomáticas/cirurgia , Adulto , Técnicas de Diagnóstico Oftalmológico , Diplopia/etiologia , Diplopia/patologia , Diplopia/fisiopatologia , Diplopia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/patologia , Dor/fisiopatologia , Dor/psicologia , Parestesia/etiologia , Parestesia/patologia , Parestesia/fisiopatologia , Parestesia/psicologia , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , Inquéritos e Questionários , Índices de Gravidade do Trauma , Resultado do Tratamento , Trismo/etiologia , Trismo/patologia , Trismo/fisiopatologia , Trismo/psicologia , Zigoma/lesões , Zigoma/fisiopatologia , Fraturas Zigomáticas/patologia , Fraturas Zigomáticas/fisiopatologia , Fraturas Zigomáticas/psicologiaRESUMO
Oral cancers associated with submucosal fibrosis-induced trismus are common. They may affect the patients' quality of life, cause nutritional deficits, and interfere with postoperative cancer surveillance. In such cases, locating desirable recipient vessels in the head and neck can be difficult. This report presents a 47-year-old man with severe trismus caused by recurrent head and neck cancer, who had received multiple free-flap reconstructions after cancer ablation. Reconstruction was successfully achieved for the bilateral defects and releasing the trismus by using simultaneous double free radial forearm flaps as a chained flow-through pattern with one residual recipient vessel combined with the bilateral myotomy of the medial pterygoid and masseter muscles, and coronoidectomy. Both flaps survived without any postoperative complication. The maximal mouth opening measured by interincisal distance was 38 mm intraoperative and 32 mm during the 3-year follow-up period. This approach may be an effective option for releasing trismus when recipient vessels are lacking.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Bucais/cirurgia , Retalho Miocutâneo/transplante , Fibrose Oral Submucosa/cirurgia , Procedimentos Cirúrgicos Bucais/efeitos adversos , Trismo/cirurgia , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/patologia , Terapia Combinada , Seguimentos , Antebraço/cirurgia , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/complicações , Neoplasias Bucais/patologia , Retalho Miocutâneo/irrigação sanguínea , Miotomia/métodos , Fibrose Oral Submucosa/complicações , Fibrose Oral Submucosa/patologia , Procedimentos Cirúrgicos Bucais/métodos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Trismo/etiologia , Trismo/fisiopatologiaRESUMO
Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.
Assuntos
Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/radioterapia , Lesões por Radiação/fisiopatologia , Radioterapia/efeitos adversos , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Intervalo Livre de Doença , Relação Dose-Resposta à Radiação , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Perda Auditiva/epidemiologia , Perda Auditiva/etiologia , Perda Auditiva/fisiopatologia , Humanos , Masculino , Mandíbula/patologia , Mandíbula/efeitos da radiação , Osteonecrose/epidemiologia , Osteonecrose/etiologia , Osteonecrose/fisiopatologia , Prognóstico , Lesões por Radiação/epidemiologia , Tolerância a Radiação , Radioterapia/métodos , Dosagem Radioterapêutica , Medição de Risco , Análise de Sobrevida , Trismo/epidemiologia , Trismo/etiologia , Trismo/fisiopatologia , Xerostomia/epidemiologia , Xerostomia/etiologia , Xerostomia/fisiopatologiaRESUMO
BACKGROUND: The utilization of transoral robotic surgery (TORS) in patients with trismus is limited because of poor surgical exposure. METHODS: This report is about a 46-year-old man with a recurrent right base of tongue cancer who had severe postradiation trismus. We performed a midline mandibular osteotomy without a lip split and this resulted in a markedly improved surgical exposure. He underwent a TORS resection of the right base of the tongue with no significant complications. RESULTS: The midline mandibular osteotomy significantly improved the surgical exposure and facilitated exposure for TORS in a patient who otherwise would not be able to undergo TORS. CONCLUSION: Utilization of a midline mandibular osteotomy allowed for increased exposure for TORS in a patient with limited mouth opening from postradiation trismus. Postoperative hemorrhage remains a significant concern and appropriate measures to mitigate the catastrophic consequences of this should be considered.