Rehabilitation of a mandibulotomy/onlay/graft-reconstructed mandible using a milled bar and a tooth- and implant-supported removable dental prosthesis: A clinical report.

Prosthodontic rehabilitation of a surgically resected/reconstructed jaw with a conventional tissue-borne dental prosthesis is often challenging, if not impossible, because of the suboptimal conditions of the soft and hard tissue topography/architecture of the reconstructed site. Placing dental implants in grafted bone to provide appropriate support, stability, and retention for prosthodontic rehabilitation offers the potential for improved oral function. There are, however, some clinical conditions for which an implant-supported removable prosthesis may be preferred to a fixed implant prosthesis. This clinical report describes the design and fabrication of a milled bar and a tooth- and implant-supported removable dental prosthesis for oral rehabilitation of a reconstructed mandible, which considers patient factors associated with oral and financial conditions, ease of oral hygiene procedures, and long-term maintenance.

From movement to models: a tribute to professor Alan G. Hannam.

This tribute article to Professor Alan G. Hannam is based on 7 presentations for him at the July 1, 2008 symposium honoring 3 "giants" in orofacial neuroscience: Professors B. J. Sessle, J. P. Lund, and A. G. Hannam. This tribute to Hannam's outstanding career draws examples from his 40-year academic career and spans topics from human evolution to complex modeling of the craniomandibular system. The first presentation by W. Hylander provides a plausible answer to the functional and evolutionary significance of canine reduction in hominins. The second presentation, by A. McMillan, describes research activities in the field of healthy aging, including findings that intensity-modulated radiotherapy improves the health condition and quality of life of people with nasopharyngeal carcinoma in comparison to conventional radiotherapy. The developments in dental imaging are summarized in the third paper by E. Lam, and an overview of the bite force magnitude and direction while clenching is described in the fourth paper by M. Watanabe. The last 3 contributions by G. Langenbach, I. Staveness, and C. Peck deal with the topic of bone remodeling as well as masticatory system modeling, which was Hannam's main research interest in recent years. These contributions show the considerable advancements that have been made in the last decade under Hannam's drive, in particular the development of an interactive model comprising, in addition to the masticatory system, also the upper airways. The final section of the article includes a final commentary from Professor Hannam.

A prospective study of the impact of nasopharyngeal cancer and radiotherapy on the psychosocial condition of Chinese patients.

BACKGROUND: Radiotherapy (RT) promises optimistic results in the treatment of nasopharyngeal cancer (NPC). The objective of the current study was to map out prospectively the impact of NPC and RT on patients from diagnosis to 1 year posttreatment. METHODS: For this study, 67 Chinese patients (46 men and 21 women) with newly diagnosed stage I or II NPC who received primary RT were recruited. Physical and psychosocial adjustments were measured by using the Rotterdam Symptom Checklist, Beck Anxiety Inventory, Beck Depression Inventory, Perceived Stress Scale, and the 36-item Short-Form Health Survey (SF-36). Semistructured clinical interviews were conducted at bimonthly intervals from pre-RT to 1 year post-RT. RESULTS: Physical and psychosocial adjustments were poorest from pre-RT to the end of RT. Rapid improvements in all areas were noted in the first 2 months post-RT and reached a plateau at around the 6th month. At 1 year, except for physical symptoms and perceived stress, patient measures recovered to their pre-RT levels. At 1 year, patients had more physical complaints (P < .001) but less perceived stress (P = .002). The percentage of patients who expressed fear of dying dropped from 28% pre-RT to 2% at 1 year. However, patients who expressed "fear of the worst happening" increased from 51% pre-RT to 57% at 1 year. CONCLUSIONS: Different periods in treatment of NPC imposed different psychosocial demands on patients. The current results indicated that the period from diagnosis to 2-month post-RT was a high-risk period both physically and emotionally. After treatment, most patients showed resilience despite persistent side effects of RT and successfully resumed their pretreatment level of functioning by the end of the year. Despite resuming a normal or near-normal living, patients still noted a subdued fear of recurrence.

Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial.

PURPOSE: To compare directly the effect of intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) on salivary flow and quality of life (QoL) in patients with early-stage nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: Fifty-one patients with T2, N0/N1, M0 NPC took part in a randomized controlled clinical study and received IMRT or CRT. Stimulated whole (SWS) and parotid (SPS) saliva flow were measured and Medical Outcomes Short Form 36 (SF-36), European Organization for Research and Treatment of Cancer (EORTC) core quetionnaire, and EORTC head-and-neck module (QLQ-H&N35) were completed at baseline and 2, 6, and 12 months after radiotherapy. RESULTS: Forty-six patients (88%) were in disease remission 12 months after radiotherapy. At 12 months postradiotherapy, 12 (50.0%) and 20 patients (83.3%) in the IMRT group had recovered at least 25% of preradiotherapy SWS and SPS flow respectively, compared with 1 (4.8%) and 2 patients (9.5%), respectively, in the CRT group. Global health scores showed continuous improvement in QoL after both treatments (p < 0.001). However, after 12 months subscale scores for role-physical, bodily pain, and physical function were significantly higher in the IMRT group, indicating a better condition (p < 0.05). Dry mouth and sticky saliva were problems in both groups 2 months after treatment. In the IMRT group, there was consistent improvement over time with xerostomia-related symptoms significantly less common than in the CRT group at 12 months postradiotherapy. CONCLUSIONS: IMRT was significantly better than CRT in terms of parotid sparing and improved QoL for early-stage disease. The findings support the case for assessment of health-related QoL in relation to head-and-neck cancer using a site-specific approach.

Preservation of quality of life after intensity-modulated radiotherapy for early-stage nasopharyngeal carcinoma: results of a prospective longitudinal study.

BACKGROUND: Xerostomia is a ubiquitous complication after conventional radiotherapy for nasopharyngeal carcinoma (NPC) that seriously impairs patient quality of life (QOL). The effect on QOL of parotid-sparing intensity-modulated radiotherapy (IMRT) for early-stage NPC was assessed prospectively. METHODS: Thirty-two patients with T1-2,N0-1,M0 NPC received IMRT. Saliva flow was measured, and the Medical Outcomes Short Form 36 (SF-36), European Organization for Research and Treatment of Cancer (EORTC) core, and EORTC head and neck module (QLQ-H&N35) questionnaires were completed at baseline and 2, 6, and 12 months after IMRT. RESULTS: Saliva flow recovered to at least 25% of baseline in most cases after 1 year. Physical function, fatigue, and vitality were problems at 2 months and then resolved (p < or = .002). Global health scales showed continuous improvement in QOL after treatment (p < or = .004). Xerostomia and sticky saliva were problems 2 months after treatment; thereafter, continuous improvement occurred (p < or = .001). Xerostomia scores correlated with general aspects of QOL (p < or = .044). CONCLUSION: IMRT for early-stage disease preserved key aspects of QOL, and a reduction in xerostomia symptoms enhanced broader aspects of QOL.

Efficacy of a novel lubricating system in the management of radiotherapy-related xerostomia.

A comparison was made of Oral Balance gel delivered by slow release via a novel intra-oral device versus an oral bolus of gel on the oral health condition and oral health-related quality of life (OHRQoL) in patients who had received standard head and neck irradiation for nasopharyngeal carcinoma. Twenty-two participants took part in a randomized single-blind crossover clinical study. Each treatment lasted 4 weeks with an intervening 4 weeks washout period. The GOHAI, Xerostomia Inventory and patient satisfaction measures were self-completed and oral health condition assessed objectively at baseline (week 0) and weeks 4, 8 and 12. Oral Balance gel, in bolus and slow-release forms, was effective in improving aspects of oral health, notably a reduction in oral cariogenic micro-organisms. Slow release of gel via the intra-oral device did not appear to improve OHRQoL whereas gel alone reduced the severity of xerostomia symptoms and was the treatment of choice.

A preliminary report on patient acceptance of a novel intra-oral lubricating device for the management of radiotherapy-related xerostomia.

Management of radiotherapy-related xerostomia is difficult. Saliva substitutes are helpful but the effects are short-lived. The purpose of the study was to develop a prototype intra-oral lubricating device for the management of radiotherapy-related xerostomia and to evaluate patient acceptance. An intra-oral lubricating device was fabricated that incorporated a reservoir in the palatal vault and permitted slow release of saliva substitute by the patient. Preliminary clinical testing was done in five patients with radiotherapy-related xerostomia. A measure incorporating seven questions was used to explore patient acceptance. The device was simple to fabricate using materials available in a technical laboratory. All patients were able to wear the device for at least 4 h per day throughout the test period. The device was considered easy to use and clean. Some impairment of speech and chewing was noted although this appeared to be related to the bulkiness of the reservoir. General oral comfort was improved due to the lubricating effect. The bulk of the reservoir was reduced as a consequence of patient feedback. The design addressed key problems associated with previous lubricating systems. Patient reports on oral functioning with the device in situ provided pivotal information on the device's utility.

Intensity-modulated radiotherapy for early-stage nasopharyngeal carcinoma: a prospective study on disease control and preservation of salivary function.

BACKGROUND: Xerostomia is a uniform complication after radiotherapy (RT) for nasopharyngeal carcinoma (NPC). Dosimetric studies suggested that intensity-modulated RT (IMRT) can spare part of the parotid glands from high-dose radiation. Disease control and salivary function after IMRT for early-stage NPC was studied prospectively. METHODS: Thirty-three patients with T1,N0-N1,M0 NPC were treated with IMRT from 2000 to 2002. The prescribed dose was 68-70 grays (Gy) in 34 fractions to gross tumor volume, 64-68 Gy to the planning target volume, and 70 Gy to enlarged cervical lymph nodes. Nineteen patients had stimulated whole salivary (SWS) flow assessment and stimulated parotid salivary (SPS) flow assessment at baseline and at 2 months, 6 months, 12 months, 18 months, and 24 months after the completion of IMRT. RESULTS: At a median follow-up of 2 years, only 1 neck failure was observed. The 2-year and 3-year local control, distant metastases-free, and overall survival rates all were 100%. The lymph node control and progression-free survival rates were 100% at 2 years and 92.3% at 3 years, respectively. The average mean dose to the parotid gland was 38.8 Gy. The SWS and SPS flow showed continuous recovery: 60% and 47.1% of patients recovered at least 25% of their baseline SPS flow and SWS flow, respectively, at 1 year after completion of IMRT, and the proportions rose to 85.7% and 71.4%, respectively, by 2 years. The pH and buffering capacity of saliva also improved with time. CONCLUSIONS: Parotid-sparing IMRT achieved good locoregional control, and there was continuous recovery of salivary flow, pH, and buffering capacity in the first 2 years after IMRT in patients with NPC.

Salivary gland function and xerostomia in southern Chinese following radiotherapy for nasopharyngeal carcinoma.

Nasopharyngeal carcinoma (NPC) is rare among Caucasians but very common among southern Chinese. No information is presently available on the relationship between salivary gland function and xerostomia in irradiated southern Chinese. Salivary gland function and xerostomia were measured in irradiated NPC patients, recently diagnosed NPC patients, and a matched control group. Stimulated whole saliva was collected from each participant and flow rate, pH and buffer capacity measured. All participants completed a multi-item dry mouth questionnaire. Comparisons were made using Chi-square and Mann-Whitney tests and correlations assessed using Spearman's rank correlation coefficients. The mean saliva flow rate and pH were significantly lower and the buffer capacity impaired in irradiated NPC patients compared with the other groups ( P<0.01). Significantly more irradiated NPC patients had negative impacts associated with dry mouth generally, sticky saliva, and hoarse voice ( P<0.01). Subjective dry mouth symptoms and associated reduced saliva flow were also relatively common in non-irradiated participants. Salivary gland hypofunction and xerostomia were major complications in irradiated NPC patients. In irradiated and non-irradiated southern Chinese, subjective dry mouth symptoms appeared to be correlated with actual salivary gland function.