[Features of dental rehabilitation of elderly patients after treatment of maxillofacial neoplasm.]

The purpose of this study is a comparative analysis of the effectiveness of the use of dental trays-transformers for the manufacture of prosthetic designs for elderly patients with acquired microstomia. Was conducted a clinical study of 12 hemimaxillectomy patients from 60 to 72 years. The 1st group included 6 patients with acquired microstomia, impressions of the jaws were obtained with dental trays-transformers. The 2nd group includes 6 patients who have less traumatic oral opening, they were removed with standard dental trays. The group of clinical control consisted of 6 patients with partial absence of maxillary teeth, who needed to prosthetic dentistry. The results of the study indicate the effectiveness of the use of trays-transformers to impressions of the jaw in elderly patients with restricted oral opening, as well as in patients with normal oral opening. Optimization of the stages of obturator prostheses allows to provide qualitative prosthetic care of patients with malignant neoplasms of the oropharyngeal region, which has a positive effect on the quality of life of elderly patients with acquired defects of the oropharyngeal region.

Robotic surgery for oropharynx cancer: promise, challenges, and future directions.

Epidemiologic studies have shown a rise in the incidence of oropharyngeal cancer without a corresponding increase in oral cavity cancers. These diverging trends are explained by human papilloma virus, which preferentially affects the oropharynx. Cancers resulting from this viral infection bear a better prognosis than those that are smoking-related. Treatment of oropharyngeal cancers has typically involved the use of radiation and chemotherapy to avoid the morbidity of mandibular splitting surgery. The use of transoral robotic surgery (TORS) has obviated the need for large-scale open approaches but still provides the pathologic staging data that is unavailable from non-surgical approaches. Although TORS is in its infancy, early functional and oncologic outcome data are promising. The complex management of oropharyngeal cancers should utilize the available treatment modalities to optimize outcomes and stratify patients to different treatment based on risk status.

Treatment referral before and after the introduction of the Liverpool Patients Concerns Inventory (PCI) into routine head and neck oncology outpatient clinics.

PURPOSE: Holistic needs assessment is a key recommendation in improving supportive and palliative care in adults with cancer. The Patients Concerns Inventory (PCI) is a holistic needs assessment tool designed for head and neck cancer survivors in outpatient setting. Routine screening of potential unmet needs in a clinic may result in increased onward referrals, thus placing a burden on existing healthcare services. The aim of this study was to compare the referral trends following consultation in the time periods before and after introduction of PCI in an oncology outpatient clinic. METHOD: A cross-sectional cohort of disease-free survivors of oral/oropharyngeal cancers of a single consultant was prospectively exposed to PCI from July 2007 to April 2009. The PCI is a self-completed questionnaire consisting of 55 items of patient needs/concern and a list of multidisciplinary professionals, whom patients may wish to talk to or be referred to. Retrospective analysis of referral patterns from clinic letters in two periods in the pre-PCI and post-PCI exposure was performed. Prospective analysis of consultations was performed to determine the outcome of PCI-highlighted items. RESULTS: There was no change in the prevalence of onward referral with the introduction of PCI, i.e. 21 referrals per 100 patients seen in outpatients. However, the proportion of referrals to oral rehabilitation and psychological support increased. Referrals to certain services, e.g. speech and language and dentistry, remained consistently in demand. Many PCI-highlighted needs were dealt in a clinic with by the consultant and/or other professionals during a multidisciplinary consultation. CONCLUSIONS: Routine use of PCI promotes target efficiency by directing and apportioning appropriate services to meet the needs for supportive care of head and neck cancer survivors.

[Buccal flap in reconstruction of mucosal defects in oral cavity]. / Plat policzkowy do rekonstrukcji ubytków blony sluzowej jamy ustnej.

INTRODUCTION: The buccal flaps are an effective alternative in treatment patients with small defects of the oral cavity due to: the small size of the flap, the lack of donor site, less risk of postoperative complications and short procedure time. MATERIAL AND METHODS: In the Department of Otolaryngology and Laryngological Oncology in Poznan in the years 2005-2008 was performed 7 resections of oral cavity due to cancer in which the reconstructions were based on two types of flaps: from the buccal mucosa (3 patients), and muscular-buccal mucosal flap (4 cases). The paper presents aspects of the anatomical structure of the cheek and technique for flap dissection. RESULTS AND CONCLUSIONS: In the majority group of patients the primary defect healing properly. The mucosal buccal flaps are a good alternative to free flaps, but their indications are limited to the primary defects of small extent.

Framework for Speech-Language Pathology Services in Patients with Oral Cavity and Oropharyngeal Cancers.

This article provides a framework speech-language pathology services to optimize functional outcomes of patients with oral cavity and oropharyngeal cancers. Key principles include (1) a proactive rehabilitation model that minimizes intervals of disuse or inactivity of speech and swallowing systems, (2) standardized evaluation paradigms that combine objective instrumental assessments with patient-reported outcome measures, and (3) systematic methods for surveillance and intensive rehabilitation for late dysphagia.

Oral rehabilitation with the new SG attachment in a patient treated for oral squamous cell carcinoma.

In patients who have undergone surgery and radiotherapy for oral squamous cell carcinoma (OSCC), the posterior oral rehabilitation may prove complex. In addition to the defects produced by surgical ablation of the primary tumor, radiotherapy induces deleterious effects upon the oral tissues. We present the case of a 48-year-old male treated two years before due to OSCC in the retromolar trigone and left lateral wall of the oropharynx. Following study of the case with clinical examination and orthopantomography, a management plan was defined involving rehabilitation of the upper dental arch with fixed ceramometallic prostheses, while in the lower arch we chose a unilateral removable prosthesis adapted to a fixed prosthesis by means of a special and versatile attachment based on a new system that functions as a fixed element but which can be removed or changed at some later date. The present clinical case illustrates this type of prosthodontic solution for the management of oncological patients of this kind.

Long-term performance of indwelling tracheoesophageal speaking valves in Chinese patients undergoing laryngectomy.

OBJECTIVES: To assess the use of indwelling tracheoesophageal speaking valves in Chinese patients undergoing laryngectomy, to identify the clinicopathologic factors for favorable outcome, and to evaluate the factors that determine prosthesis lifetime. DESIGN: Retrospective review. SETTING: Tertiary care institution. PATIENTS: Sixty consecutive patients with total laryngectomy were included. All had indwelling tracheoesophageal speaking valves for voice restoration. INTERVENTION: Anterograde replacement of voice prosthesis in case of failure of functional speech production or leakage of saliva. MAIN OUTCOME MEASURES: Incidence of successful tracheoesophageal speech rehabilitation for daily communication, influence of different clinicopathologic factors on the outcome, and prosthesis lifetime and its relationship to different clinicopathologic factors. RESULTS: The success rate of speech rehabilitation was 78%. Age younger than 60 years was the only clinicopathologic factor associated with successful speech rehabilitation (P = .04, Fisher exact test). The median device lifetime was 8.2 months. Both age of 60 years or older and the use of subsequent prosthetic valves were identified as risk factors for valve failure on univariate analysis (n = 192; log-rank test; P = .02 and P = .03, respectively), with age of 60 years or older as the only risk factor that reduced the device lifetime in the Cox proportional hazards model (P = .03; relative hazard ratio, 1.5; 95% confidence interval, 1.1-2.4). CONCLUSIONS: Our success rate in using indwelling tracheoesophageal speaking valves was comparable to that reported in the Western literature. The median device lifetime of 8.2 months was satisfactory. Patient age was found to be a significant predictor of successful tracheoesophageal speech rehabilitation, with age of 60 years or more adversely affecting device lifetime.

Survey of oral rehabilitation in a consecutive series of 130 patients treated by primary resection for oral and oropharyngeal squamous cell carcinoma.

The purpose of this study was to investigate the use of oral rehabilitation in a group of patients who had primary resection of oral and oropharyngeal squamous cell carcinoma. Of 132 consecutive patients operated on for previously untreated disease between January 1995 and June 1997, 130 were recruited. The University of Washington Quality of Life questionnaire was completed on the day before operation at 6 and 12 months, and at last review. A larger similar dataset was used to predict survival. Twenty-eight patients (22%) were seen by the oral rehabilitation team. The median (IQR) time from operation to start of treatment was 12 months (6-21). The median (IQR) time from beginning to end of rehabilitation was 14 months (5-49). Patients with larger tumours (P=0.06) and patients who were edentulous with dentures in the maxilla (P=0.07) were most likely to be seen for oral rehabilitation.

Prospective evaluation of quality of life in patients with oral and oropharyngeal cancer: from diagnosis to three months post-treatment.

The purpose of this study was to examine the impact of surgical, radiotherapeutic and combination treatment on quality of life, in patients diagnosed with cancer of the oral cavity and oropharynx. During the acute stage of treatment, quality of life was longitudinally evaluated. Quality of life was assessed at frequent time intervals (diagnosis, two weeks, 1 month and 3 months after treatment completion). Eligible patients were consecutively requested to participate and 38 patients were recruited. Participants completed the EORTC QLQ-C30, EORTC H&N35, and HADS questionnaires. Functioning was found to reduce immediately post-treatment, with most functions improving to near baseline levels by 3 months post-treatment. Many symptoms significantly increased post-treatment, with many still scoring greater than at baseline levels at the end of the study. Anxiety scores were highest at diagnosis, depression scores were low throughout. This study indicates quality of life alters significantly over a short period of time from diagnosis and the start of treatment.

Composite resection with mandibulectomy in the treatment of posterolateral oral cavity and lateral oropharynx squamous cell carcinoma.

From 1972 to 1987, 403 patients underwent a composite resection consisting of segmental mandibulectomy and neck dissection for the treatment of bucco-pharynx squamous cell carcinoma (303 patients had postoperative radiotherapy [XRT], 29 patients had preoperative XRT, and 100 patients had tissue salvage performed after XRT). Of the 303 patients who received preoperative XRT, 32 were clinically staged T2, 149 were staged T3, and 122 were staged T4; 194 of the 303 patients were staged N0. In the 100 patients who experienced relapse and who required "salvage surgery," the restaging found 20 patients staged T2, 39 staged T3, and 41 staged T4; 73 of the 100 patients were staged N0. The patients' mean postoperative stay was 15 days for those who had prior surgery and 21 days for those who had salvage surgery. With a minimum follow-up of 5 years, locoregional recurrences and postoperative death occurred in 86 of 274 patients (31%) in whom surgery and postoperative XRT were performed; in 17 of 29 patients (59%) who had preoperative XRT performed; and in 61 of 100 patients (61%) who had salvage surgery performed. In addition, in terms of functional results, only 61% of patients (206) were able to maintain normal speech function, and only 23% (91) were able to maintain normal oral feeding. Of the 403 patients, the 5-year survival rates were 33% for the overall population, 42% for patients with postoperative XRT, 16% for patients in whom operation was performed after preoperative XRT, and 17% for patients who underwent salvage surgery.

Functional effects of a free jejunum flap used for reconstruction in the oropharyngeal region.

Postoperative articulatory function was assessed in 5 patients who had had radical operations for cancers of the oropharyngeal region with surgical reconstruction using free jejunum flaps. A patient with total resection of the soft palate had the lowest scores of 39.9%. 4 patients with less resection than total removal of the soft palate had good scores (86.0%), and the articulatory dysfunction was limited only in plosive sounds produced in the velar region. A comparative study with glossectomized patients revealed that those who had had resection of the oropharynx achieved excellent articulation except for sounds produced in the velar region. The importance of operative function was stressed, to evaluate indications for the surgical technique for reconstruction of large tissue defects after ablation of head and neck cancers, and to improve the quality of life of those patients.

Improvement in oral function following tumour surgery by a combination of tongue plasty by the Steinhäuser technique and osseointegrated implants.

Oral functions such as speaking, chewing and swallowing are often reduced after ablative tumour surgery in the mouth and oropharynx. For restoration of at least a part of these functions, stable dentures and satisfactory mobility of the tongue are necessary. Dental implants can be used to achieve stable dentures. Pre-implant surgery, however, is often needed to reduce the amount of bulky tissue when myocutaneous flaps have been used for reconstruction, and to achieve adequate mobility of the tongue. A combination of tongueplasty by the Steinhäuser technique and osseointegrated implants will be described and discussed. Twelve patients have been treated by this technique between 1992 and 1995, with a mean follow up of 11.6 months. All patients reported an improved tongue mobility and ability to chew. Tongueplasty by the Steinhäuser technique with secondary epithelialization, in combination with osseointegrated implants, is a simple and effective means of improving oral function.

Two stage reconstruction with revascularized grafts after resection of retromolar and oropharyngeal carcinoma.

The clinical outcome of two stage reconstruction with revascularized grafts after resection of extensive retromolar and oropharyngeal squamous cell carcinoma in 17 patients is presented. In the first operation, the intraoral soft tissue defect was covered by a revascularized jejunal flap, and the mandibular defect was bridged by a reconstruction plate. After a period of 5-28 months, mandibular reconstruction was performed with a microsurgically revascularized iliac crest graft that was positioned under the jejunal graft. Clinical follow up included tumour recurrence rate, the form of nutrition, speech disorders and mouth opening restrictions. Quality of life was analysed by the EORTC questionnaires. Fifteen patients were free of recurrence and alive. Twelve patients were able to swallow food. The jejunal flap provided perfect lining of the soft palate, the pharynx and the base of the tongue, thus supporting functional restoration. Despite the gravity of disease and invasiveness of therapy, the two stage procedure leads to satisfying functional and aesthetic results thus obtaining appropriate QOL.

Outcome after radial forearm, gastro-omental, and jejunal free flaps in oral and oropharyngeal reconstruction.

We undertook a retrospective study of the outcome of radial forearm, gastro-omental, and jejunal free tissue transfer for oral and oropharyngeal reconstruction in 30 patients (10 in each group). No significant differences were found between the type of free flap and the clinical outcome. More long-term difficulties were experienced with swallowing than with speech. The selection of free flap did not correlate with speech function (P=0.44), swallowing (P=0.68), or management of saliva (P=0.59). No significant difference was found between the patients' outcome and the site of resection of the tumour. There were more complications after gastro-omental flaps and this may influence the choice of reconstruction.

[Primary reconstructive operations in cancer of the mouth mucosa and oropharynx]. / Pervichno-rekonstruktivnye operatsii v khirurgii raka slizistoi obolochki rta i rotoglotki.

An analysis of primary reconstructive surgical treatment of 254 patients with carcinoma of the mouth mucosa and oral pharynx was made. The character of operative procedures for different localizations of the tumour is described. The primary reconstructive surgical treatment was shown to reduce the amount of postoperative complications to 11.4%, to keep intact the natural ways of respiration and nutrition at the early postoperative period. If without recidivation, about 70% of the patients continued working.

Management of oropharyngeal cancer: a cross-sectional review of institutional practice at a large Canadian referral centre.

BACKGROUND: Over the years, the treatment of oropharyngeal cancer has changed; in the past, first-line treatment consisted of surgery followed by adjuvant radiotherapy, today however, primary treatment typically involves concomitant chemoradiation, and reserves surgery for salvage. While chemoradiation is the modality of choice for primary management of oropharyngeal cancer, disease characteristics, institutional bias, and patient preferences influence treatment choice. This has lead to variation in the treatment of OPC, and has generated some uncertainly regarding the ideal therapeutic approach. The objective of this study was to describe the treatment of OPC a large Canadian referral center, highlighting trends in treatment choice and outcome. METHODS: This is a cross-sectional retrospective review of clinical practice at Sunnybrook Health Science Centre (Toronto, ON). This investigation documents type of first-line treatment, rates of treatment failure, rates of surgical salvage, and 5-year disease-free survival. This study also asses the therapeutic impact of free-flap reconstruction on the use of a postoperative tracheostomy and/or percutaneous endoscopic gastrostomy tube. RESULTS: The majority of oropharyngeal cancer patients presented with regionally metastatic disease (stage III-IV) and underwent concomitant chemoradiation as first-line treatment. Just over half of patients who failed chemoradiation were eligible for salvage surgery. Forty-six percent of salvage patients recurred at approximately 6 months, and died approximately 12 months following the first sign of disease recurrence. Five-year survival for salvage patients stage II, III, IVA, and IVB was 100%, 54.5%, 53.8%, and 50%, respectively. The incidence of percutaneous endoscopic gastrostomy tubes and tracheostomies was comparable between patients who underwent free-flap reconstruction and patients who did not. CONCLUSION: The modality of choice for first-line treatment of oropharyngeal cancer is concomitant chemoradiation. The moderate failure rate following chemoradiation and the modest survival rate following salvage surgery could indicate that selected patients may benefit from undergoing surgery as first-line treatment. While this study did not show that functional outcomes were better for free-flap patients, it is highly likely that those who received a free-flap did better then they would have had they not undergone reconstructive surgery. More research regarding the therapeutic effects of free-flaps in OPC survivors is needed.

Functional assessment and rehabilitation: how to maximize outcomes.

The number of oral cavity and oropharyngeal cancer survivors is rising. By 2030, oropharyngeal cancers are projected to account for almost half of all head and neck cancers. Normal speech, swallowing, and respiration can be disrupted by adverse effects of tumor and cancer therapy. This review summarizes clinically distinct functional outcomes of patients with oral cavity and oropharyngeal cancers, methods of pretreatment functional assessments, strategies to reduce or prevent functional complications, and posttreatment rehabilitation considerations.

Rehabilitation needs of patients with oropharyngeal cancer.

Swallowing and swallowing-related impairments present important posttreatment challenges in individuals undergoing organ preservation therapy for head and neck cancer. Literature pertinent to this topic is reviewed. A protocol for treatment of speech and swallowing deficits related to oropharyngeal cancer and treatment performed at Johns Hopkins Hospital is described. Data collected from a sample of oropharyngeal patients with cancer, with and without human papillomavirus-related disease, are summarized. Future directions for further study of this population are discussed.

Reverse facial-submental artery island flap for reconstruction of oropharyngeal defects following middle and advanced-stage carcinoma ablation.

To assess the reliability of the reverse facial-submental artery island flap for reconstruction of oropharyngeal defects after resection of intermediate stage and advanced carcinomas, we studied 13 patients with stage III and IV squamous cell carcinoma (SCC) of the oropharynx. They had all had their tumours excised followed by reconstruction of the oropharyngeal defect using a facial-submental artery island flap. There was no major failure of a flap, but two minor ones. The marginal mandibular branch of the facial nerve remained intact and undamaged. All donor sites healed well and scars were well-hidden. The functional results of speech and swallowing after 10-28 months' follow-up were satisfactory. One patient developed lung metastases. The facial-submental artery island flap is a simple, reliable flap that can be used for reconstructing oropharyngeal defects after resection of medium and advanced carcinomas of the oropharynx.