[Speech Ability and Psychological Outcome After Treatment of Oral Cancer]. / Sprechqualität und psychische Beeinträchtigung nach der Therapie von Mundhöhlentumoren.

BACKGROUND: In recent years interactions between surgical treatment of oral carcinoma and incidence of anxiety or depression have become a subject of discussions. This prospective study is a comparison between the extent of loss of speech intelligibility and presence of depressive symptoms or anxiety as a result of oral carcinoma. MATERIAL AND METHODS: One year after surgical therapy for oral carcinoma, 90 patients of an average age of 60±12 years were examined. Their speech intelligibility degree was measured using standardized automatic speech recognition (word recognition rate, WR). Symptoms of anxiety and depression were detected by use of HAD-Scales (HADS). Next to the relationship between WR and HADS other influential variables related to WR and HADS were statistically evaluated. RESULTS: The WR average was 53.2±17.2. Female WR was better than male. The difference between tumor classifications T1 and T4 compared to the WR reached statistical significance. Significant differences were detected between WR and "tumor localization", "graft donor site", "graft morphology", "tongue motility", and "tracheostoma" groups. There was a relationship between tongue motility and graft morphology, graft donor site and tumor localization. HAD-Scores in the mean were elevated: HADS-Total=43.3%, HADS-A=43.3% und HADS-D= 51.1%. WR correlates with HADS-D-Subscale, but not with HADS-A-Subscale. CONCLUSION: Communication disorders as a result of neoplasmic orofacial surgery may be related to extent of the treatment and to affective impairments. This should receive attention in the concept of rehabilitation.

[Intraoperative frozen section diagnosis of head and neck tumors: possibilities, limitations, pitfalls and tips for the daily practice]. / Intraoperative Gefrierschnittdiagnostik von Kopf-Hals-Tumoren : Möglichkeiten, Grenzen, Fallstricke und Ratschläge für die tägliche Praxis.

Intraoperative consultation (synonym: frozen section diagnostics) has increasingly gained significance for the daily practice in head and neck surgery. The main aim of this investigation method which is usually associated with much stress and effort is to facilitate an optimal and timely oncological surgical treatment of neoplastic diseases with a minimum rate of postoperative functional disturbance. In order to achieve this purpose pathologists are expected to deliver as much correct information as possible to accurately influence intraoperative surgical decisions. At the same time this aim should be reached without significantly and unnecessarily increasing the workload for the pathology laboratory and without significantly inducing tissue artifacts. This would otherwise negatively influence the tissue quality for permanent section examination and consequently the overall quality of diagnosis and tumor staging. Thus, the quality and efficacy of frozen sections span a spectrum with the highest quality having the least possible false negative rate on the one hand and a false positive result of approximately zero on the other hand. Sticking to this approach would result in a high positive impact on the surgical treatment of a variety of neoplastic diseases and help to minimize or even eliminate the rate of medicolegal consequences.

[Speech intelligibility degree and coping after multimodal therapy of oral squamous carcinoma]. / Sprachverständlichkeit und Krankheitsverarbeitung nach der Therapie von Mundhöhlenkarzinomen.

BACKGROUND: Multimodal treatment of oral cancer can cause speech disorders and diminish speech intelligibility. Speech intelligibility is an essential part of social interaction and therefore important for coping with the disease. The aim of this study was to investigate the influence of speech intelligibility on coping strategies and a standardized questionnaire. PATIENTS AND METHODS: Speech recordings from 76 patients 60.7 ± 11.4 years old (19 women, 57 men) were performed at least 6 months after multimodal treatment of T1-T4 squamous cell carcinoma of the oral cavity and evaluated by automatic speech recognition. Speech intelligibility was quantized as correctly recognized words of a standard text (word recognition rate WR). Coping was evaluated by the Trier Scales of Coping Strategies via questionnaires. RESULTS: Speech intelligibility scores WR rated between 22.2% and 84.3% (mean value 54.2 ± 15.7). Coping strategies vary considerably between the patients and between the scales. WR and the Trier Scales significantly correlate in 3 of the 5 categories (Rumination, Search for Information and Exchange of Experiences). CONCLUSION: Reduced speech intelligibility after multimodal treatment of oral cancer is associated with a change of coping strategy. This includes not only communication-based strategies (Search for Information and Exchange of Experiences) but also intra-psychic processes like rumination.

Prospective assessment of complications associated with ultrasound activated resorbable pin osteosynthesis in pediatric craniofacial surgery: preliminary results.

Ultrasound activated resorbable pin osteosynthesis (UARPO) has recently shown favourable results in operations on children suffering for craniosynostosis. However, data on complications coming with this new technique in children suffering from craniosynostoses are scarce and have only been assessed retrospectively so far. It has been the aim of the present study to prospectively follow up children undergoing craniosynostosis surgery with a focus on complications related to UARPO materials. Ten pediatric patients (3 female/7 male) were operated due to craniosynostosis at an average age of 9.1±3.8 months using UARPO (SonicWeld/Resorb-X, KLS Martin, Tuttlingen, Germany). Clinical followup evaluations were carried out 1, 3, 6, 9, 12 and 18 months after surgery according to signs of local infection, stability of the remodeled cranial vault and the palpability of the osteosynthesis material. If secondary surgery was necessary, the indication was documented and evaluated by histological and wound smear examinations. No intra-operative or postoperative complications during the inpatient period occurred. 3 patients needed secondary operation due to a localized chronic swelling at the former incision site which developed 3, 9 and 12 months after the operation. Histological examinations yielded a giant cell formation surrounding the resorbable materials in all cases. Additionally, the wound smear showed a bacterial infection in one site. The current prospective study is the first in the field. It reveals a high percentage of delayed foreign body reactions with UARPO, bearing the need of secondary surgery. It seems that this high complication rate found in the present prospective study may weigh out the advantages of UARPO.

Automatic, computer-based speech assessment on edentulous patients with and without complete dentures - preliminary results.

Dental rehabilitation of edentulous patients with complete dentures includes not only aesthetics and mastication of food, but also speech quality. It was the aim of this study to introduce and validate a computer-based speech recognition system (ASR) for automatic speech assessment in edentulous patients after dental rehabilitation with complete dentures. To examine the impact of dentures on speech production, the speech outcome of edentulous patients with and without complete dentures was compared. Twenty-eight patients reading a standardized text were recorded twice - with and without their complete dentures in situ. A control group of 40 healthy subjects with natural dentition was recorded under the same conditions. Speech quality was evaluated by means of a polyphone-based ASR according to the percentage of the word accuracy (WA). Speech acceptability assessment by expert listeners and the automatic rating of the WA by the ASR showed a high correlation (corr = 0.71). Word accuracy was significantly reduced in edentulous speakers (55.42 +/- 13.1) compared to the control group's WA (69.79 +/- 10.6). On the other hand, wearing complete dentures significantly increased the WA of the edentulous patients (60.00 +/- 15.6). Speech production quality is significantly reduced after complete loss of teeth. Reconstitution of speech production quality is an important part of dental rehabilitation and can be improved for edentulous patients by means of complete dentures. The ASR has proven to be a useful and easily applicable tool for automatic speech assessment in a standardized way.

[Swallowing-related quality of life in oral cavity cancer. The German version of the Anderson Dysphagia Inventory]. / Schluckbezogene Lebensqualität bei Mundhöhlenkarzinomen. Anderson-Dysphagia-Inventory, deutsche Version.

BACKGROUND: The objective of this study was to validate the German version of the Anderson Dysphagia Inventory (ADI), as well as to grade it by using health-related quality of life as an external criterion. PATIENTS AND METHODS: A total of 102 patients (26 women, 76 men) aged 34-90 years (61.1+/-10.8) with a treated squamous cell carcinoma of the oral cavity participated in the study. All study participants independently completed the German version of the ADI and the SF-36 questionnaire on health-related quality of life. The German ADI was tested for its validity and reliability, and subjected to a factor analysis. RESULTS: The internal consistency reliability of the ADI was calculated using Cronbach's alpha coefficient and was equal to 0.942. In the split-half reliability the Spearman-Brown coefficient scored 0.916. Factor analysis showed a one-factor result. The correlation coefficients between the point scores of the German ADI and the following clinical parameters demonstrated construct validity: radiation (p<0.001), T-classification (p=0.002), surgical method (p=0.018), not, however, tumor site (p=0.115). The grading system was as follows: scores <55 are regarded as "definitely noticeable"; scores 55-70 are considered as "more noticeable than not"; while scores >70 are classified as " more unnoticeable than not". CONCLUSION: The German translation of the ADI is a validated and reliable method to assess swallowing-related quality of life.

[Intelligibility of children with bilateral and unilateral cleft lip and palate]. / Sprachverständlichkeit von Kindern mit bilateralen und unilateralen Lippen-Kiefer-Gaumen-Spalten.

OBJECTIVE: Data about the effect of unilateral or bilateral cleft lip and palate (CLP) on speech quality are inconsistent. In this study we firstly quantify the intelligibility of children with unilateral and bilateral CLP objectively by means of automatic speech recognition system (ASR). METHODS: Speech data of 72 German speaking children (8.7+/-3.0 years) with CLP thereof 17 children with bilateral CLP, 23 with CLP on the right side, and 32 on the left, were compared. A group of 159 children aged 9.1+/-2.9 years served as control group. To quantify intelligibility we calculated the word recognition rate (WR) as the percentage of correctly recognized words of a standardized speech test (PLAKSS). RESULTS: Between the 3 cleft groups, there was no significant difference in WR. Compared to the control group (WR mean 63.5%+/-12.1%), the patient group (WR mean 48.1%+/-16.3%) shows significant lower WR (p< 0.001). The WR rises with increasing age in the control group and in the patient groups with unilateral cleft significantly. This couldn't be observed in the children with bilateral CLP. In this group the males showed a significantly higher WR than the females. In the control group as in the patient groups with unilateral cleft there is no significant difference between girls and boys. CONCLUSIONS: Despite the greater extent of the malformation of children with a bilateral CLP, there is no significant difference to the children with only a unilateral cleft lip and palate.

Gingival esthetics and oral health-related quality of life in patients with cleft lip and palate.

While the oral health-related quality of life (OHRQoL) is known to be reduced in patients with cleft lip and palate (CLP), its inter-dependency with the soft tissue characteristics of the CLP area remains unclear. This study aimed to evaluate the soft tissue characteristics in the treated cleft area in order to investigate whether gingival esthetics correlate with OHRQoL. Thirty-six patients with unilateral or bilateral CLP (46 cleft areas) were investigated after secondary/tertiary alveolar bone grafting and orthodontic/prosthetic implant treatment using an adapted score to rate gingival esthetics (clinical esthetic score, CES). The patient's OHRQoL was determined using the German short version of the Oral Health Impact Profile questionnaire (OHIP-G14). The results showed a significantly better rating in patients with their own teeth in situ (12.05±1.10) than in patients with implants (6.95±4.78) or prosthetics (4.00±3.58). The best OHRQoL values were achieved by patients with their own teeth integrated into the cleft area (1.32±2.31), followed by patients with implants (2.33±2.33) and prosthetics (3.75±5.87). A significant (P=0.017) correlation was found between OHIP-G14 and CES scores, suggesting an increased OHRQoL in cases with higher oral esthetics in the cleft area. The therapeutic strategy contributes to both gingival esthetics and OHRQoL. The patient's subjective perception of OHRQoL can be attributed to objective gingival esthetic ratings.

[Injuries and overuse syndromes due to rock climbing on artificial walls]. / Verletzungen und Uberlastungssyndrome beim Klettern an künstlichen Kletteranlagen.

The purpose of this study was to obtain an overview of acute injuries and chronic overuse syndromes due to rock climbing on artificial climbing walls. Strategies for prevention should then be developed based on these experiences. From October 1995 to December 1996 314 climbers of both sexes and all degrees of climbing abilities were individually interviewed at five different indoor climbing arenas with the help of a special questionnaire. Type, quantity and cause of typical injuries and overuse syndromes on artificial climbing walls were determined. Injuries (n = 204) as well as overuse syndromes (n = 266) increased with the performance level. Experienced climbers often suffered from injuries to the finger flexor tendons (n = 42) and the finger flexor pulleys (n = 37) while holding small grips. Beginners sustained skin injuries (n = 26) and joint distortions (n = 22) of the lower limb while falling. Reasons are a lack of experience in the techniques of belaying and falling as well as incomplete covering of the ground with crash mats. Chronic overuse syndromes mainly presented as swelling and pain in the finger joints (n = 140) and as epicondylitis in the elbow (n = 30). Especially knee problems (n = 12) were caused by new climbing techniques used on artificial climbing walls. Referring to injuries as well as to overuse syndromes climbing on artificial climbing walls is a very safe sport, compared to climbing on natural rock. Further prevention could be provided by a well-based instruction of beginners, especially in techniques of belaying and falling. The ground of climbing walls should always be completely covered by sufficient crash mats. More experienced climbers should minimize harmful climbing techniques, like using very small holds with a cling grip, long distance reaches and inside rotation of the leg under pressure.

Factors influencing relative speech intelligibility in patients with oral squamous cell carcinoma: a prospective study using automatic, computer-based speech analysis.

Oral squamous cell carcinoma (OSCC) and its treatment impair speech intelligibility by alteration of the vocal tract. The aim of this study was to identify the factors of oral cancer treatment that influence speech intelligibility by means of an automatic, standardized speech-recognition system. The study group comprised 71 patients (mean age 59.89, range 35-82 years) with OSCC ranging from stage T1 to T4 (TNM staging). Tumours were located on the tongue (n=23), lower alveolar crest (n=27), and floor of the mouth (n=21). Reconstruction was conducted through local tissue plasty or microvascular transplants. Adjuvant radiotherapy was performed in 49 patients. Speech intelligibility was evaluated before, and at 3, 6, and 12 months after tumour resection, and compared to that of a healthy control group (n=40). Postoperatively, significant influences on speech intelligibility were tumour localization (P=0.010) and resection volume (P=0.019). Additionally, adjuvant radiotherapy (P=0.049) influenced intelligibility at 3 months after surgery. At 6 months after surgery, influences were resection volume (P=0.028) and adjuvant radiotherapy (P=0.034). The influence of tumour localization (P=0.001) and adjuvant radiotherapy (P=0.022) persisted after 12 months. Tumour localization, resection volume, and radiotherapy are crucial factors for speech intelligibility. Radiotherapy significantly impaired word recognition rate (WR) values with a progression of the impairment for up to 12 months after surgery.

Outcome measurements after oral cancer treatment: speech and speech-related aspects--an overview.

INTRODUCTION: Oral cancer and its surgical treatment impair speech quality by an alteration of the vocal tract. Local size and stage of the tumour as well as surgical and adjuvant treatment modalities have an impact on the functional outcome of patients' speech rehabilitation. It was the aim of this overview to specifiy speech and speech-related aspects as well as to delineate measurement methods of speech outcome in patients with oral cancer by a review of the literature. METHODS: The review is based on a Medline Search on "speech", "cancer", "oral cancer", "malignoma mouth", "intelligibility", "formant", "ultrasound". DISCUSSION: In particular, speech intelligibility is inevitable for the social interaction of patients which is highly correlated with the patient's quality of life. However, speech outcome measurement shows a variety of methods without an international standardisation. Additionally, several co-aspects of speech production have to be considered: tongue mobility, voice production, velopharyngeal closure and neural coordination are important influencing factors. Speech assessment is traditionally performed by perceptual methods on a subjective or semi-subjective base. More objective, technical-based methods of speech evaluation are in development and under research. PURPOSE: It was the aim of this overview to specify speech and speech-related aspects as well as to delineate measurement methods of speech outcome in patients with oral cancer by a review of the current literature.