Analysis of the Clinical Status and Treatment of Facial Cellulitis of Odontogenic Origin in Pediatric Patients.

The most common cause of the development of odontogenic infection is untreated dental caries, which initially leads to pulpitis. If an odontogenic infection is left untreated, it will pass through the limiting bone plate and will infiltrate deeper structures. Odontogenic infections are different in adults and children. The study was conducted at the Department of Pediatric Otolaryngology and Pediatric Head and Neck Surgery of Upper Silesian Children's Health Center in Katowice in the 2020-2022. We included 27 patients aged 2-16 in the study. Patients were diagnosed with an active, acute odontogenic inflammatory process in the head and neck area. We assessed pain, trismus, extraoral and intraoral swelling and the level of CRP [C Reactive Protein], WBC [White Blood Cells], NLR [Neutrophil Lymphocyte Ratio], D-dimers and Prealbumins. The results were analyzed in terms of the location of the source of inflammation: maxilla or mandible and the type of source of infection: deciduous tooth or permanent tooth. Deciduous teeth are more often the cause of odontogenic infection in the maxilla, while permanent teeth in the mandible. Trismus, extraoral, and intraoral swelling occurred in all infections caused by permanent teeth. The CRP and NLR ratio is statistically higher in infection, which originates from permanent teeth. The mean hospitalization time was also longer for infections from permanent teeth 3.42 days than for deciduous teeth 2.2 days. The varied clinical picture of odontogenic infections in children requires periodic analyzes of statistical data related to epidemiology, etiology, and symptomatology in order to update diagnostic and therapeutic procedures.

Does the use of cooled saline irrigation during third molar surgery affect post-operative morbidity?

Design This study is a double-blind, single-centre, split-mouth, prospective randomised control trial. In total, 48 patients had bilateral third molars removed during two separate operations at least 21 days apart by the same maxillofacial surgeon. During the control operation, the tooth was irrigated with saline at 25°C. During the test operation, patients were randomised to tooth irrigation with saline at either 10°C (n = 24) or 4°C (n = 24). Local anaesthetic, flap design, burr design and sutures remained consistent throughout. Patients were prescribed amoxicillin, chlorhexidine and were advised to take paracetamol as needed. The patients remained blinded to which test group they were randomised to and to the order of the control or test operations performed. Participants self-recorded analgesia use and post-operative pain daily for seven days using a visual analogue scale (VAS). A second maxillofacial surgeon examined patients on days one, three and seven. Facial swelling was assessed by measuring the distance between various soft tissue points compared to pre-operative levels. Trismus was determined by measuring maximum inter-incisal opening compared to pre-operative levels.Case selection In total, 28 female and 20 male medically fit adult patients with a mean age of 24.6 ± 3.8 with bilateral mandibular asymptomatic third molar teeth were selected. Second molars with periodontal probing depths >4 mm or impacted third molars associated with cysts or tumours were excluded. Patients had no antibiotic prescription in the preceding month nor analgesic consumption in the 12 hours before surgery.Data analysis The Shapiro-Wilk test was used to evaluate if the sample fit a normal distribution. Relationships between the categorical variables of the groups was tested using chi-square statistics. Data comparisons were examined with the Duncan, Kriskal-Wallis, Dunn and Friedman test (p <0.05).Results The median duration of the control and test group operations were similar (p = 0.051). Test group patients reported lower pain VAS values and consumed less analgesics compared to the control groups (p = 0.001), with the lowest values seen in the 4°C group (p <0.001). A greater decrease in trismus levels was also seen on day three and seven in the test groups (p <0.001) compared to the control group (p = 0.07). Swelling was greatest in the control group (p <0.001) and reduced on day seven (p <0.001) in all groups. While trismus and swelling values were lower in the 10°C test group compared to the control (p <0.001), the lowest values of these parameters at all time points was in the 4°C group (p <0.001).Conclusions Early complications following third molar removal include facial swelling, trismus and pain. In this study, intraoperative cooled saline irrigation to 4°C and 10°C was more effective than saline irrigation at 25°C in reducing the intensity of these conditions.

Single blind, randomized study comparing clinical equivalence of Trusilk ® and Mersilk ® silk sutures for mucosal closure following surgical removal of mesioangular impacted mandibular third molar.

Background: Mesioangular impacted mandibular third molar is a common dental anomaly, for which surgical extraction is required. Post-surgery closure of mucosa reduces the prevalence of pain and other surgery-associated complications. We compared tissue reaction/inflammation after 3 and 7 days of mucosal closure with Trusilk ® and Mersilk ® silk sutures, following impacted mandibular third molar removal. Methods: This multicenter, prospective, two-arm, parallel-group, randomized (1:1), single-blind study (July 2020-November 2021) included subjects (Trusilk ®, n=65 and Mersilk ®, n=64), requiring mucosal suturing following impacted mandibular third molar removal. The primary endpoint, incidence of pain, swelling and trismus at the extraction area on post-surgery day 3 and 7 was evaluated. The secondary endpoints, incidence of tissue reaction, wound infection, suture loosening, other complications, operative time, amount of anesthesia, intraoperative suture handling, time needed for complete wound healing and suture removal, and adverse events were also recorded. Results: Socio-demographic and intra-oral characteristics were comparable between the groups. In Trusilk ® and Mersilk ® groups, a gradually decreasing pain score, starting from day 0 post-surgery (42.17±22.38 vs. 45.97±22.20) to day 7 (8.40±11.93 vs. 8.28±12.13) to day 30 (1.98±0.89 vs. 1.75±0.76) was witnessed. After the surgery, 21.54% and 17.19% subjects in Trusilk ® and Mersilk ® groups, respectively, had no post-operative swelling, while at the last two visits none of the subjects had swelling. Non-significant difference in wound infection, suture loosening, wound healing, bleeding, taste changes, operative time, amount of anesthesia, intraoperative suture handling, and time needed for complete wound healing and suture removal was noted among the groups. No suture-related adverse events were recorded. Conclusions: The results indicated that the Trusilk ® and Mersilk ® silk sutures are clinically equivalent and can be used for mucosal closure after removal of an impacted mandibular third molar with a minimal rate of pain, swelling and trismus. Clinical Trial Registry of India Registration: CTRI/2020/03/024100 (20/03/2020).

Peritonsillar abscess due to temporomandibular joint septic arthritis: an uncommon cause of a common disease.

Peritonsillar abscess is a common presentation of complicated acute tonsillitis. The temporomandibular joint septic arthritis is an uncommon clinical entity while its complications are further rare. We present a case of a man in his late 30s who presented with a painful swelling in the left preauricular region along with increasing trismus. A diagnosis of peritonsillar abscess due to septic arthritis was made based on clinical history and examination. Patient recovered fully after antibiotic and abscess drainage. This is the first case report of temporomandibular septic arthritis leading to peritonsillar abscess.

Age-Specific Clinical Features of Pediatric Malignant Hyperthermia: A Review of 187 Cases Over 60 Years in Japan.

BACKGROUND: Malignant hyperthermia (MH) is an inherited muscle disorder induced by volatile anesthetics and depolarizing muscle relaxants. While the incidence of MH is high in young, there are few reports on the clinical features of pediatric MH. In this study, we selected pediatric cases from an MH database and analyzed the clinical findings by age group. We hypothesized that there would be age-related differences in the clinical characteristics. METHODS: A retrospective analysis of MH data collected in our database during 1960 to 2020 was performed to identify pediatric subjects (≤18 years) with a Clinical Grading Scale of ≥35, indicating "very likely" or "almost certain" MH. We compared clinical characteristics among the 0 to 24 month, 2 to 12 year, and 13 to 18 year (youngest, middle, and oldest, respectively) age groups. RESULTS: Data were available for 187 patients: 15 in the youngest age group, 123 in the middle-aged group, and 49 in the oldest age group. Of these, 55 patients (29.4%) had undergone muscle biopsy and muscle contracture test. The mortality rates during the study period were 13.3%, 13.8%, 20.4%, and 15.5% in the youngest, middle, and oldest cohorts and overall, respectively. In contrast, the overall mortality rate from 2000 to 2020 was 8.8%. The most frequent initial symptoms of MH were elevated temperature (46.7%) and generalized muscular rigidity (26.7%) in the youngest cohort, masseter spasm (35.0%) and generalized muscular rigidity (19.5%) in the middle cohort, and elevated end-tidal carbon dioxide (26.5%) and tachycardia (22.4%) in the oldest cohort. Physical examination revealed that elevated temperature, sinus tachycardia, and respiratory acidosis occurred frequently in all groups. The middle cohort had high frequencies of masseter spasm (58.4%; P = .02) and dark urine (75.5%; P = .01) compared to those in the oldest groups, and had a higher peak creatine kinase level compared to those in the 3 groups. Skeletal muscle symptoms tended to be more common in patients administered succinylcholine (generalized muscular rigidity, P = .053; masseter spasm, P < .0001; dark urine, P < .0001). In particular, masseter spasm and dark urine were more common in the middle cohort when succinylcholine was administered (masseter spasm: versus youngest cohort, P = .06, versus oldest cohort, P = .027; dark urine: versus youngest cohort, P = .0072, versus oldest cohort, P = .0015). CONCLUSIONS: The clinical characteristics of pediatric patients with MH vary according to age group. The difference in initial symptoms of MH depending on age group is noteworthy information for the early diagnosis of MH.

Further validation of the Gothenburg Trismus Questionnaire (GTQ).

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.

Does preoperative dental anxiety play a role in postoperative pain perception after third molar surgery?

Background: Surgical removal of the impacted third molar is associated with inflammatory morbidities which include swelling, trismus, and pain. Pain is the most common postsurgical morbidity associated with third molar surgery. It remains an important factor in patients' perception of recovery after third molar surgery with dental anxiety reported to exert influence on its threshold. Objective: The aim of the study was to determine if preoperative dental anxiety has any significant role on postoperative pain perception after third molar surgery. Materials and Methods: This was a cohort study involving sixty consecutive adult patients requiring extraction of impacted mandibular third molars under local anesthesia. Modified Dental Anxiety Scale Questionnaire was administered to each participant in the waiting area before the surgery. The visual analog scale was also given to each participant to be completed once daily at approximately the same time as the surgery time until day 7 after the surgery. Data collected were analyzed using SPSS version 23. Results: Sixty participants who consented to third molar surgery took part in this study. Five participants were lost to follow-up. There were slightly more males (50.9%) than females (49.1%). Nineteen participants in this study had moderate dental anxiety (34.5%) and 6 participants (11%) had severe dental anxiety with more females having moderate-to-severe dental anxiety. The correlation between pain perception at different days and dental anxiety was not significant (P > 0.05). Conclusion: Preoperative dental anxiety may not significantly influence pain perception after third molar surgery.

RésuméContexte: L'extraction chirurgicale de la troisième molaire incluse est souvent accompagnée d'un gonflement, d'une difficulté à ouvrir la bouche et de douleurs. La douleur est la morbidité post-chirurgicale la plus courante associée à la chirurgie de la troisième molaire. C'est un facteur important qui détermine la façon dont les patients perçoivent la guérison après une chirurgie de la troisième molaire. Il est rapporté que l'anxiété dentaire a une influence sur le seuil de douleur des patients. Objectif: Pour déterminer si l'anxiété dentaire préopératoire a un rôle significatif sur la perception de la douleur postopératoire après une chirurgie de la troisième molaire. Méthodes: Soixante patients adultes nécessitant l'extraction des troisièmes molaires incluses sous anesthésie locale ont été inclus dans cette étude de recherche. Un Modified Dental Anxiety Scale Questionnaire a été administré à chaque participant dans la salle d'attente avant la chirurgie. Le Visual Analogue Scale (VAS) a également été donnée à chaque patient à compléter une fois par jour à peu près au même moment que l'heure de la chirurgie jusqu'au jour 7 après la chirurgie. Les données obtenues ont été analysées à l'aide de la version 23 de SPSS. Résultats: Soixante patients ayant consenti à une chirurgie de la troisième molaire ont participé à cette étude. Cinq patients ont été perdus de vue. Il y avait un peu plus d'hommes (50,9%) que de femmes (49,1%). Dix-neuf patients avaient une anxiété dentaire modérée (34,5%) et 6 (11%) une anxiété dentaire sévère, un plus grand nombre de femmes ayant une anxiété dentaire modérée à sévère. La corrélation entre la perception de la douleur à différents jours et l'anxiété dentaire n'était pas significative (P> 0,05). Conclusion: L'anxiété dentaire préopératoire peut ne pas avoir d'effet significatif sur la perception de la douleur après une chirurgie de la troisième molaire.

Validação para a língua portuguesa do Gothenburg Trismus Questionnaire (GTQ) / Validation of the Portuguese version of the Gothenburg Trismus Questionnaire

Atualmente, o Gothenburg Trismus Questionnaire (GTQ) é o único questionário de qualidade de vida específico sobre trismo. A afecção, definida como restrição à abertura da boca, gera prejuízo a atividades habituais como comer, engolir, falar e fazer a higiene oral, trazendo grande desconforto aos pacientes. A tradução de questionários de qualidade de vida desempenha um importante papel no conhecimento da saúde das populações nos diferentes países. O objetivo do presente estudo é apresentar a validação do GTQ para a língua portuguesa, a fim de permitir sua aplicação efetiva nas populações de idioma português. O GTQ foi validado com sucesso para a língua portuguesa conforme os seguintes passos: Tradução, Retradução (back translation), Adaptação cultural e Revalidação.

Currently, the Gothenburg Trismus Questionnaire (GTQ) is the only quality-of-life questionnaire specific for the assessment of trismus. The disease, characterized by limited mouth opening, impairs usual activities such as eating, swallowing, talking, and performing oral hygiene, causing great discomfort to patients. Translation of quality-of-life questionnaires plays an important role in promoting health awareness in the populations of different countries. This study aimed to validate the Portuguese version of the GTQ to allow its effective application in Portuguesespeaking populations. The Portuguese version of the GTQ was successfully validated through the following steps: translation, back translation, cultural adaptation, and revalidation.

Spontaneous Temporomandibular Joint Dislocation.

Dislocation of the temporomandibular joint (TMJ) is the displacement of the head of the condyle from its normal position in the glenoid fossa. Anterior dislocations are the most common type of TMJ dislocations. Prognathism of the lower jaw, anterior crossbite, and open bite are the classic features in bilateral TMJ dislocations.The treatment of acute TMJ dislocation involves manual reduction with or without general anesthesia. The use of maxillomandibular fixation is reserved for chronic, more complex dislocations. Determining the presence of a predisposing factor is very important in guiding the correct treatment and management for this condition.The authors present a case of acute spontaneous temporomandibular joint dislocation where multiple predisposing factors were recognized, requiring treatment with maxillomandibular fixation after manual reduction.

Long-term functional and esthetic outcomes after fibula free flap reconstruction of the mandible.

BACKGROUND: The goal of this study is to report functional and esthetic outcomes, after fibula free flap (FFF) reconstruction of the mandible for oral cancer, assessed by physicians, nonclinicians, and patients. METHODS: Twenty-five long-term survivors from oral cancer after FFF reconstruction were recalled for head and neck examination by surgeons, for photographs and patient-reported outcomes, using EORTC, QLQ-C30, H&N35, and FACE-Q questionnaires. RESULTS: Physicians reported 64% restoration of functionality compared to normal. Patients reported high scores on QLQ-C30 but lower scores on H&N35. Esthetic scores were reported higher by clinicians than nonclinicians. The decline in function and appearance was attributed to loss of lower dentition, trismus, malocclusion, xerostomia, and tissue atrophy. CONCLUSION: To minimize the decline in function and appearance, immediate dental implants in FFF, better reconstruction of the temporomandibular joint, newer methods of radiotherapy to minimize xerostomia and oral exercises to prevent trismus should be considered.

Prevalence and prediction of trismus in patients with head and neck cancer: A cross-sectional study.

BACKGROUND: Trismus occurs frequently in patients with head and neck cancer. Determining the prevalence and associated factors of trismus would enable prediction of the risk of trismus for future patients. METHODS: Based on maximal mouth opening measurements, we determined the prevalence of trismus in 730 patients with head and neck cancer. Associated factors for trismus were analyzed using univariate analyses and multivariate logistic regression analyses. Based on the regression model, a calculation tool to predict trismus was made. RESULTS: Prevalence of trismus was 23.6%. Factors associated with trismus were: advanced age; partial or full dentition; tumors located at the maxilla; mandible; cheek; major salivary glands; oropharynx; an unknown primary; a free soft tissue transfer after surgery; reirradiation; and chemotherapy. CONCLUSION: About one-fourth of patients with head and neck cancer develop trismus. Based on prevalence and associated factors of trismus, a simple calculation tool predicts the risk of trismus in these patients.

Severe trismus and contraindicated exodontia in a patient with fibrodysplasia ossificans progressiva: case report.

Fibrodysplasia ossificans progressiva is a rare genetic disease of connective tissue in which muscles, ligaments, and tendons ossify either spontaneously or after trauma. Patients can develop physical disabilities and restriction of respiratory function. A patient attended a maxillofacial surgery outpatient clinic with severe trismus and mouth opening limited to 2mm. The risks of intervention were many from both anaesthetic and surgical perspectives, which prevented the extraction of carious teeth. The patient was referred to a special care dentistry team who provided endodontic stabilisation without local anaesthesia. In the case of severe infection, surgical intervention would be challenging to justify.

Osteochondroma of the coronoid process of the mandible.

We describe a rare case of osteochondroma of the coronoid process of mandible accompanied by severe trismus in a 14-year-old Japanese boy. The patient had initially been diagnosed as having internal derangement of the temporomandibular joint (TMJ), and conservative treatment had failed to improve the symptoms. Despite extremely limited TMJ movement, panoramic radiography revealed no abnormality, but magnetic resonance imaging suggested internal derangement of the left TMJ. Five months later, the trismus worsened and computed tomography revealed a bone-like mass confluent with the coronoid process, which was finally diagnosed as osteochondroma. The patient then underwent intra-oral coronoidectomy.

Temporomandibular disorders, trismus and malignancy: development of a checklist to improve patient safety.

Trismus is a restriction in the ability to open the mouth. Trismus can occur following trauma, surgery, radiation therapy, infection, inflammatory diseases, temporomandibular disorders (TMD) or less commonly as a result of malignancy. Following two cases of delayed diagnosis of carcinoma presenting with features of TMD to a specialist clinic, a checklist was developed for completion in cases of trismus, to alert the clinician to suspicious features suggesting a possible non-TMD cause. The use of this checklist, together with an increased awareness, has improved early recognition of atypical features in patients presenting with trismus and has contributed to the early diagnosis of a further case of malignancy presenting to this clinic. This article discusses the presentation of malignancy with trismus, the relevance of imaging in these cases, and the implementation of a checklist to reduce the risk of future misdiagnosis.

Airway compromise by dislodged obturator in a patient with severe trismus.

A patient presented with impending airway obstruction due to a dislodged interim maxillary obturator. The removal was complicated by the presence of severe trismus due to previous maxillectomy and recent radiotherapy. An emergency tracheotomy with the patient under local anesthetic was required to provide a definitive airway and to permit subsequent removal of the obturator with the patient under general anesthesia. The situation highlights the risks associated with interim obturators while awaiting the provision of an ideally fitted, well-retained, definitive obturator. Displaced obturators are potentially life threatening and difficult to remove in emergency situations.

Prevalência e caracterização do trismo em pacientes tratados por câncer de cabeça e pescoço / Prevalence and characterization of trismus in patients treated for head and neck cancer

Introdução: O câncer de cabeça e pescoço acomete diversas estruturas do trato aerodigestivo superior e seu tratamento pode ser multimodal ou exclusivo envolvendo cirurgia (CR), radioterapia (RDT) e quimioterapia (QT). O câncer assim como seu tratamento pode levar a diversas alterações funcionais, entre elas a limitação na abertura da boca, o trismo. Esta complicação geralmente afeta hábitos de vida diária, como alimentação e higiene oral. Assim, pode haver significativo impacto na qualidade de vida. Objetivos: Avaliar pacientes com câncer de cabeça e pescoço submetidos a tratamento cirúrgico e/ou radioquimioterápico quanto à presença de trismo, identificar a prevalência de trismo e características comuns para o seu desenvolvimento nestes pacientes, além do seu impacto na qualidade de vida. Material e Método: Estudo descritivo que avaliou pacientes do A.C. Camargo Cancer Center, tratados por câncer de cabeça e pescoço. A avaliação foi composta de anamnese, medida de máxima abertura vertical (MAV) bucal com um paquímetro, avaliação da dor pela Escala Visual Analógica (EVA) e avaliação da qualidade de vida pelo questionário de qualidade de vida da Universidade de Washington. Foram incluídos no estudo 313 participantes entre 19 e 89 anos, de ambos os sexos, diagnosticados e tratados por câncer de boca, orofaringe, seios paranasais ou nasofaringe. Foram excluídos aqueles que apresentavam recidivas ou comorbidades não controladas. Resultados: A prevalência do trismo na amostra estudada foi de 30%. O maior número de indivíduos com trismo esteve presente nos grupos que apresentavam tumores em estádio clínico mais avançado (T3, 37%; T4, 55%) que realizaram tratamento curativo combinado (CR+RDT+QT, 43%; CR+RDT, 39%; RDT+QT, 39%), e que necessitaram de sonda de alimentação enteral por mais tempo (Com trismo, Média = 71 dias; Sem trismo, Média = 44 dias). Estes dados foram significativos na análise multivariada. O trismo não apresentou relação...

Introduction: Head and neck cancer (HNC) affects several structures the upper aerodigestive tract and its treatment can be uni or multimodal. It may involve surgery (S), radiotherapy (RT) and chemotherapy (CT). Cancer and its treatment can lead to several functional changes, including limitation of mouth opening, diagnosed as trismus. This complication usually affects daily living habits, such as food intake and oral hygiene. Thus, there may be a significant impact on quality of life. Purpose: To evaluate patients with HNC who underwent surgery and / or chemoradiotherapy for the presence of trismus, indentify characteristics associated with this complication and its impact on quality of life. Materials and Methods: This is a descriptive study assessing trismus in HNC patients treated at A. C. Camargo Cancer Center. The evaluations consisted of an interview, measurement of mouth opening with a caliper, pain assessment by visual analogue scale (VAS) and quality of life evaluation with the University of Washington Quality of Life Questionnaire. The study included 313 participants aged 19-89 years, of both genders, diagnosed and treated for cancer of the mouth, oropharynx, paranasal sinuses or nasopharynx. Patients who had relapses or uncontrolled comorbidities were not considered eligible for the study. Results: The prevalence of trismus in the sample was 30%. Trismus was more frequent in the groups that had more advanced clinical stage (37%, T3; 55%, T4), who underwent combined curative treatment (S + RT + CT, 43%; S + RT, 39%; RT + CT, 39%), and those who required enteral feeding tube for longer periods (with trismus, Mean = 71 days; No trismus, Mean = 44 days). These data were confirmed by multivariate analysis. No relationship was found between the presence of trismus and age (p = 0.26) or gender (p = 0.13), tumor location (p = 0.139), total dose (p = 0.92) and modality of RT (p = 0.078). The presence of trismus was correlated with surgical reconstruction...

Dental extractions prior to radiotherapy to the jaws for reducing post-radiotherapy dental complications.

BACKGROUND: Radiotherapy as part of head and neck cancer treatment leaves patients requiring much dental rehabilitation in a compromised environment that is difficult for the patient and the dental team to manage. OBJECTIVES: To assess the effects of maintaining the patient's natural dentition during radiotherapy in comparison to extracting teeth before radiotherapy in areas that are difficult to access by the patient and the dentist, should reduction in mouth opening occur after radiotherapy to the jaws. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 22 November 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 11), MEDLINE via OVID (1946 to 22 November 2012), EMBASE via OVID (1980 to 22 November 2012), CANCERLIT via PubMed (1950 to 22 November 2012), CINAHL via EBSCO (1980 to 22 November 2012) and reference lists of articles. We advertised for currently ongoing studies via the Cochrane Oral Health Group website and the Cochrane Oral Health Group Twitter feed.  SELECTION CRITERIA: Randomised controlled trials comparing extraction of teeth prior to radiotherapy with leaving teeth in situ during radiotherapy to the jaws. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed the results of the searches for inclusion in the review.  MAIN RESULTS: No randomised controlled trials were found. AUTHORS' CONCLUSIONS: There are no randomised controlled trials to assess the effect of extracting teeth prior to radiotherapy compared to leaving teeth in the mouth during radiotherapy to the jaws.