Rehabilitation in the treatment of mandibular condyle fractures.

BACKGROUND: The objective of rehabilitation after the treatment of a mandibular condyle fracture is to retrieve the effortless, symmetrical opening of the jaws with the preservation of appropriate movements to the sides, and appropriate occlusion without a sense of tension in the mastication muscles or pain sensations. OBJECTIVES: The aim of the article was to establish the conditions of the rehabilitation of temporomandibular joint (TMJ) after the surgical treatment of a fractured condyle. MATERIAL AND METHODS: The research featured 46 of patients treated surgically between January 2, 2017 and December 30, 2017. The open reduction and rigid internal fixation (ORIF) was the method mainly applied. Rehabilitation with the use of the Delphi technique was implemented in each patient. The assessment of the mastication organ was mostly performed at 3 and 6 weeks since the beginning of rehabilitation. In every patient, the interincisal distance was measured; in chosen cases, the range and trajectory of the condyle movements, and the trajectory of the secant point during jaw opening were defined with the use of the Zebris® JMA device. RESULTS: In 45 patients, a full reposition and immobilization of 52 bone fragments of fractured mandibular condyles was obtained. The displacement of the midline of the mandible in occlusion or an incorrect occlusion contact determined the decision on the application of intermaxillary fixation in 8 patients for a period of 2 weeks. The minimal jaw opening of 40 mm was achieved in 41 patients after 6 weeks of rehabilitation. In 5 of the rest of the patients, rehabilitation had to be continued. The reassessment of the X-ray images and additional computed tomography (CT) diagnosis in three-dimensional (3D) reconstruction in those patients revealed the possible causes of difficulties in the restoration of the stomatognathic system functions ­ the injuries of the muscles or ligaments connected with the joint. CONCLUSIONS: The extension of radiological diagnostics with a CT examination may improve the assessment of the restored TMJ function after the surgical treatment of a fractured mandibular condyle.

Fatty acids distribution and content in oral squamous cell carcinoma tissue and its adjacent microenvironment.

Squamous cell carcinoma of the oral cavity mucosa grows under conditions of poor oxygenation and nutrient scarcity. Reprogramming of lipid biosynthesis accompanies tumor growth, but the conditions under which it occurs are not fully understood. The fatty acid content of the serum, tumor tissue and adjacent tumor microenvironment was measured by gas chromatography in 30 patients with squamous cell carcinoma grade 1-3. Twenty-five fatty acids were identified; their frequencies and percentages in each of the environments were assessed. Nineteen of the twenty-five fatty acids were found in tumor tissue, tumor adjacent tissue and blood serum. Of them, 8 were found in all thirty patients. Percentages of C16:0 and C18:1n9 were highest in the tumor, C18:1n9 and C16:0 were highest in tumor adjacent tissue, and C16:0 and C18:0 were highest in blood serum. The frequencies and amounts of C22:1n13, C22:4n6, C22:5n3 and C24:1 in tumor adjacent tissues were higher than those in blood serum, independent of the tumor grade. The correlations between the amount of fatty acid and tumor grade were the strongest in tumor adjacent tissues. The correlations between particular fatty acids were most prevalent for grade 1+2 tumors and were strongest for grade 3 tumors. In the adjacent tumor microenvironment, lipogenesis was controlled by C22:6w3. In blood serum, C18:1trans11 limited the synthesis of long-chain fatty acids. Our research reveals intensive lipid changes in oral cavity SCC adjacent to the tumor microenvironment and blood serum of the patients. Increase in percentage of some of the FAs in the path: blood serum-tumor adjacent microenvironment-tumor, and it is dependent on tumor grade. This dependency is the most visible in the tumor adjacent environment.

Psychological characteristics versus swallowing and speech rehabilitation efficiency in patients after oral cavity cancer excision.

Introduction: Personality traits of the patients surgically treated due to oral cancer form anxiety and depression levels associated with body deformation, as well as life quality during illness, and they are also associated with life span of the patients. It is purposeful to take personality traits into account during treatment management and rehabilitation of the patients. The aim of work is to recognize the association between personality traits and functional rehabilitation course in the patients treated due to oral cancer. Materials and methods: 100 patients (W ­ 42, M ­ 58; 55.78 ±11.68 years) surgically treated due to oral cavity squamous carcinoma. Patients participated in the rehabilitation of oral functions. Wound healing course, postoperative facial deformity, breathing, swallowing, and speech were assessed in relation to "self-image", "body image", and "the level of acceptance of the disease" according to the Adjective Check List ACL-37, Body Cathexis Scale, and Illness Acceptance Scale after 2, 4, and 12 weeks post-surgically. Results: Greater swallowing efficiency after 4 weeks post-surgically was present in patients with a stronger need for order and endurance. Patients who achieved greater speech efficiency in the 4th week post-surgically accepted their illness in a greater part. Patients in whom post-surgical deformity was greater showed lesser intensity in: achievements, domination, endurance, self-exposure, spontaneity in interpersonal contacts. These patients are characterized with lower self-reliance and greater need for counselling.

Compensatory Mechanisms in Patients After a Partial or Total Glossectomy due to Oral Cancer.

Excision of a part or the whole of tongue due to oral cancer disturbs swallowing and speech. Lower airways aspiration of the swallowed bolus in patients after such oral structures excision is a symptom of major swallowing disorder and may be the cause of aspiration pneumonia. Restoration of oral nutrition is possible after exclusion or reduction of aspiration threat in the patients. Video fluoroscopic evaluation of the swallowing performed at the beginning of the swallowing rehabilitation in 95 patients after a total or partial glossectomy due to oral cancer, who assessed their saliva swallowing as efficient on the day of examination, showed disturbances of all of the swallowing stages. The most common disturbances involved the oral stage: limited mobility of the oral tongue, impaired glossopalatal seal, and weak glossopharyngeal seal. The most serious among them involved pharyngeal stage of swallowing, as leakage into the larynx and aspiration. The patients used their own methods during barium suspension swallowing to facilitate the swallowing act. They used such methods as: changing the position of the head to the body, additional swallows, engaging the adjacent structures into sealing the oral fissure. We assumed that the compensatory mechanisms (CM) worked out by the patients before the swallowing examination will enable them efficient barium suspension swallowing. The CM were applied by 71 of 95 patients; 51 of the patients used more than one compensatory mechanism. Swallowing in 61 of the compensating patients was at least functional; swallowing in 10 of the compensating patients was non-efficient and caused recurrent aspiration. The results of our research negate the validity of multiple swallows (more than three) without apnea elongation because it may lead to aspiration. Aspiration was also recorded in patients with weak airways closure and immovable epiglottis, who complemented the impaired oral transport with gravitational oral transport by moving chin up during a swallow. The hypothesis that CM applied by the patients after oral cancer excision during saliva swallowing will be helpful in swallowing of the barium suspension was not proved. In 10 of all the patients recurring aspiration was found despite CM application. Determination of aspiration risk is the key to efficient swallowing rehabilitation. The assessment of CM applied spontaneously by the patients' maintenance validity is particularly important. Video fluoroscopic examination of swallowing allows to assess the aforementioned issue and is crucial for better comprehension of CM applied by the patients in creating a new swallowing pattern after oral cancer excision.

The role of the epiglottis in the swallow process after a partial or total glossectomy due to a neoplasm.

Repeatable epiglottic movement patterns were recorded during a videofluoroscopic swallow evaluation of 95 patients who had undergone a total or partial glossectomy due to a neoplasm. Because no epiglottic function assessment was performed preoperatively, for the purpose of this study it was assumed that epiglottic mobility was "normal" during this time and that all abnormalities found afterward resulted from the growth of the neoplasm and the glossectomy. It was noted that in the early postoperative period, absence of epiglottic movement was accompanied by aspiration and made swallowing incompetent in a majority of cases (9 of 10). A correlation of movement between the epiglottis and the extent of oral tissue excision was found. Epiglottic mobility was evaluated as "normal" in 72% of the patients, i.e., in 67 of 91 (74%) patients after a partial or nearly total glossectomy and in 1 of 4 people who underwent a total glossectomy. In the subgroup (16%) of patients who underwent a total or nearly total glossectomy and then had videofluoroscopic examinations, 60% of the cases had normal epiglottic movements and 40% had an immobile epiglottis. Compensatory mechanisms implemented by the patients on their own initiative, such as additional swallows and prolonged apnea during deglutition, enabled them to avoid aspiration. However, upward head movement and downward chin tilting during deglutition as compensatory mechanisms used by patients with no epiglottic movement did not reduce the aspiration risk in the early postoperative period and were found to accompany incompetent swallowing attempts.

[Hyoid bone position and tongue size and patency of upper airway structures]. / Pozycja kosci gnykowej i jezyka a droznosc górnych dróg oddechowych.

INTRODUCTION: Maintenance of the patency of upper airway structures and sufficient ventilation are extremely important for children and adolescents because of influence on physical and mental development. Many clinicians analysing characteristics of patients with obstructive sleep apnoea syndrome have reported association between craniofacial abnormalities and respiratory disorders in the upper respiratory tract. PURPOSE: The purpose of this study is to examine relationship between position of hyoid bone and clinical symptoms of respiratory disorders in the upper airway. MATERIAL AND METHODS: One hundred patients participated in this study (range 9 - 35 years), all of them with evidence of craniofacial changes and abnormal dental patterns. Data were gained by clinical inspection of the naso-, oro- and hypopharynx, plaster cast analysis and cephalometric analysis according to Hasund, suppplemented by non-specific soft tissue and skeletal parameters. RESULTS: Breathing disorders in upper airway tract appear in 67 from 100 patients. Respiratory disorders with increasing severity are described: breathing with the mouth open, snoring and sleep apnoea syndrome. Statistical analysis showed differences in hyoid bone position and tongue size between patients with and without breathing disorders. CONCLUSION: Increased displacement of the hyoid bone, correspond to severity of breathing disorders. The hyoid bone in patients with upper airway obstruction is more inferiorly and posteriorly located.

[Evaluation of oral and pharyngeal phase of swallowing after glossectomy due to neoplasm]. / Ocena zaburzen ustnej i gardlowej fazy polykania po wycieciu jezyka z powodu nowotworu.

INTRODUCTION: Glossectomy is a disability that leads to dysphagia. AIM: To define oral and pharyngeal dysfunctions with regard to the extent of tongue excision and swallowing efficiency. MATERIAL AND METHODS: 62 patients were videofluoroscopically examined 2 weeks to 3 months after surgery. Oral and pharyngeal disturbances were analyzed according to W.J. Dodd. RESULTS: Impaired tongue movement and absence of oral transport were the most frequent oral dysfunctions. Lack of glossopharyngeal closure and abnormal epiglottis mobility were the most frequent pharyngeal dysfunctions. CONCLUSIONS: Oral phase abnormalities are the result of resection of anatomical structures, while pharyngeal abnormalities are due to a delay in pharyngeal phase initiation and defect of synchronization. Videofluoroscopy is a fundamental method to define oral and pharyngeal dysfunction.

[The delay of pharyngeal phase initiation vs the course of the deglutition act in patients after partial or total tongue excision due to oral cancer]. / Opóznienie inicjacji gardlowej fazy polykania a przebieg aktu polykania u chorych po czesciowym lub calkowitym wycieciu jezyka z powodu nowotworu.

PURPOSE: The coordination of the respiratory and alimentary function is indispensable to transport the food from the oral cavity to the stomach without aspiration risk. Disturbances during pharyngeal phase of swallowing, registered after oral tumour excision, are caused by diminishing of the tongue shape, decreasing of gustatory sensitivity and oral stereognosis. The aim of the work is to estimate the influence the oral tissue excision to the pharyngeal phase of deglution. MATERIAL AND METHODS: videoradiological examination of deglutition by W.J. Dodds - for 95 patients after oral tumour excision, with swallowing disturbances. Duration of oral and pharyngeal activities, degree of realization these activities and aspiration risk were valued. RESULT: Abnormal mobility of tongue, lack of palato-pharyngeal and glosso-pharyngeal closure, abnormal formation of bolus accompanied to delayed initiation of pharyngeal phase. The delay of pharyngeal phase initiation was the most important for beginning and ending of the larynx closure, oesophagus opening, pharynx emptying. This delay wasn't statistically significant for duration these activities. The retention in oral cavity and in lower throat, additional deglutitions, inter-deglutition and postdeglutition leakage correlated with delay of the pharyngeal phase initiation. CONCLUSIONS: 1. The delay of pharyngeal phase initation after oral tumour excision is caused by oral swallowing disturbances. 2. The delay of pharyngeal phase initiation after oral tumor excision is dependent on the range of surgery and reconstruction. 3. The delay of pharyngeal phase initiation after oral tumour excision is important for beginning and ending of the pharyngeal phase activities, it isn't important for their duration. 4. The deficit of oral sensory stimuli causes desynchronization of the pharyngeal phase activities and diminishes the swallowing efficiency. 5. Improvement of the swallowing efficiency after partial or total tongue excision is possible by oral phase elongation, by monitoring of the swallowing apnea and by multiple deglutitions.

[Pronunciation and swallowing in patients with tongue deficits following resection of oral cavity tumor]. / Wymowa i polykanie u chorych z pooperacyjnymi ubytkami jekzyka po wyciekciu nowotworu jamy ustnej.

PURPOSE: Anatomical changes due to resection of oral cavity neoplasm result in respiratory, swallowing, pronunciation and mastication disorders of varying extent and intensity. The aim of this study was to assess the quality of pronunciation and efficiency of deglutition in patients operated due to oral cavity neoplasm. MATERIAL AND METHODS: 112 patients (76 males, 36 females, mean age 53 years) after oral tumor excision were examined. Pronunciation quality was evaluated audio-visually using phonemes of contemporary Polish language (according to Roclawski) which were pronounced alone, in syllables and words. Compensatory function was studied as well. Efficiency of deglutition was examined with videofluoroscopy (according to W. J. Dodds). Oral and pharyngeal activities were analyzed and quantified using a 100 - point scale. RESULTS: Speech and swallowing disorders of varying intensity were observed in every patient. The frequency and quality of abnormal phonation and the presence of characteristic compensatory mechanisms depended on the extent of post-operative deficits and functional efficiency of adjacent structures. There was a statistically significant correlation between the quality of pronunciation and efficiency of deglutition.

[Breathing disorders after resection of structures in the oral cavity, throat and neck studied by pulse oximetry examinations]. / Zaburzenia oddychania po rozlegllych zabiegach operacyjnych w jamie ustnej, gardle i szyi na podstawie wyników badán pulsoksymetrycznych.

INTRODUCTION: Surgical treatment of oral cavity neoplasms consists of the resection of tumor surrounded by a healthy tissue margin. This study is aimed at an objective, qualitative and quantitative evaluation of breathing disturbances and dyspnoea after the resection of oral cavity structures, throat structures and muscles of the neck. For the purpose of evaluating the above-mentioned disturbances an attempt was made to carry out pulse oximetry examination. MATERIAL AND METHODS: We have examined 50 persons after the resection of oral cavity structures, throat structures and muscles of the neck in Maxillofacial Clinic of Pomeranian Medical Academy in Szczecin. The examinations were performed by pulse oximetry set during sleep before and after operations. The patients were divided into three groups according to the type of removed structures which included: lateral part of the mandible; mental part of the mandible; part of the tongue. RESULTS: The results of examinations obtained gave rise results as: pulse oximetry examination revealed an increased incidence of blood desaturation episodes and a decrease in minimum saturation level. CONCLUSIONS: Surgical treatment of oral cavity neoplasms leads to breathing disturbances. Apnoea episodes cause a drop in the arterial blood saturation with oxygen.

[Observations of diagnosis and treatment of the salivary gland tumors]. / Spostrzezenia dotyczace rozpoznawania i leczenia nowotworów slinianek.

Morphological and imaging methods of diagnosis and therapy of salivary gland tumors were presented. They have changed in period of thirty years. The accuracy of pretreatment diagnostic methods increased from 40 to 90%. Wrong diagnoses repeated in cases: adenoid cystic carcinoma, mucoepidermoid carcinoma and metastases from other organs. Their frequency in our material was 21.2%. Changes in treatment of pleomorphic adenoma and adenoid cystic carcinoma were described. Percentage of 5-years survival was 64% in irradiated after tumor excision all treated. The patient's active participation in functional rehabilitation after facial nerve reconstruction was accentuated.