American Cancer Society Head and Neck Cancer Survivorship Care Guideline.

Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society.

Associations of oral health items of the Vanderbilt Head and Neck Symptom Survey with a dental health assessment.

OBJECTIVES: The Vanderbilt Head and Neck Symptom Survey (VHNSS) version 2.0 oral symptom subscale addresses underreported oral health issues. We report the associations of xerostomia, dental health, dentures and trismus questions with oral examination findings. MATERIALS AND METHODS: Between May 2011 and April 2012, fifty head and neck cancer (HNC) patients treated with chemoradiotherapy completed the 50-item VHNSS survey, an oral health assessment by a dentist, salivary flow, and inter-incisal opening (IIO) measurements. RESULTS: Patient reported "problems with dry mouth" correlated with unstimulated salivary flow (-0.43, p=0.002). "Cracked teeth" (0.55, p=<0.001) or "difficulty chewing due to teeth" (0.43, p=0.004) correlated with urgent/emergent dental issues identified on clinical exam. Scores of >4 on any dental question identified 83% of patients with urgent or emergent needs. The ROC curve separated routine from urgent/emergent dental issues (0.89, p<0.001). IIO correlated with reported jaw movement "limitations" (-0.43, p=0.002). Small numbers of patients with dentures precluded meaningful analysis of this subsample. CONCLUSIONS: Clinically significant oral health issues pertaining to xerostomia, dental health and trismus may be identified using the oral health subscale of the VHNSS version 2.0. MASCC guidelines should be followed by patients with xerostomia. The observation that a score of >4 is highly predictive of dental issues is important and needs further validation. If confirmed, this would be a useful screening tool for identifying and referring HNC patients for dental care. Patients with trismus should receive physical therapy.

Reliability and validity of self-assessment of mouth opening: a validation study.

BACKGROUND: The objective of this study was to evaluate the reproducibility and validity of patients' mouth opening measurements in a research setting. METHODS: Firstly, 68 patients made repeated self-measurements of mouth opening using a cardboard scale (Therabite Range of Motion Scale - TRMS). Secondly, 80 patients enrolled in a clinical trial on morbidity after lower third molar surgery, made daily assessments during the postoperative week. Patients' measurements were then compared to gold-standard clinicians' measurements. RESULTS: Reliability of patients' measurements was excellent with an intraclass correlation coefficient of 0.92. The patient's measurements correlated well with the gold-standard clinician's measurements, both for the first 68 patients (Pearson's rho ranging from 0.86 to 0.90, p < 0.0001) as well as for the 80 patients enrolled in the clinical trial (rho = 0.82, p < 0.0001 at day 2, rho = 0.83, p < 0.0001 at final visit). CONCLUSIONS: TRMS can be used by patients to produce reproducible and valid mouth opening measurements.

Visual analogue scale assessment of postoperative swelling. A study of clinical inflammatory variables subsequent to third-molar surgery.

Subsequent to removal of impacted lower third molars the interrelationship of four postoperative variables (swelling, pain, trismus, and dysphagia) was assessed. Patient assessment of postoperative swelling using a visual analogue scale (VAS) was easily accepted by a group (n = 40) of patients aged 17 to 46 years. A significantly positive correlation (r = 0.66, p less than 0.01) existed between metric extraoral swelling and VAS-assessed swelling; however, the latter may represent a more sensitive method when swelling is discrete. Both extraorally and VAS-assessed swelling showed no correlation with dysphagia and VAS-assessed pain. Trismus correlated moderately positively with pain and extraoral swelling (r = 0.38, p less than 0.05) and dysphagia (p less than 0.01). In the present study dysphagia showed no correlation with pain. This study shows that registration of postoperative swelling by means of a VAS may be a sensitive and accurate method with obvious practical advantages.