Extraoral Maxillofacial Prosthetic Materials: Results of the 2020 International Survey.

PURPOSE: To report the results of a 2020 international survey of the most commonly used materials and techniques for the fabrication of extraoral maxillofacial prosthetics, and to assess the use of 3D technology. MATERIALS AND METHODS: A 43-question survey was administered via Qualtrics to the members of the American Academy of Maxillofacial Prosthetics (AAMP), the International Anaplastology Association (IAA), and the International Society of Maxillofacial Rehabilitation (ISMR). The use of current 3D technology in the fabrication of maxillofacial prostheses as well as barriers to care such as patient cost and insurance coverage were also assessed. RESULTS: In total, 134 respondents (13%) completed the survey; 96 (73%) reported that they were currently fabricating maxillofacial prostheses and were thus included in the survey. The majority of respondents reported currently using Silastic MDX4-4210 BioMedical Grade Elastomer (DuPont) with either Silastic Medical Adhesive Silicone Type A or Silastic MDX4-4210 crosslinker. Incorporating the use of current CAD/CAM technology was reported by a majority of respondents (58%; 45/77); however, a small cohort (33%, 15/45) reported they were still experimenting how best to use technology. A total of 39 clinicians (49%) reported that facial prosthetics were most often paid for by the patient (fee for service), with the fees ranging from $10 to $5,500 USD. CONCLUSIONS: The results of this survey indicate that current CAD/CAM technology has been adopted and incorporated into the design and fabrication of maxillofacial prostheses. More research is needed to advance CAD/CAM technology as well as the physical and mechanical properties of materials in maxillofacial prosthetics and anaplastology clinical practice. Int J Prosthodont 2023;36:570-580.

Self-Reported Trismus: prevalence, severity and impact on quality of life in oropharyngeal cancer survivorship: a cross-sectional survey report from a comprehensive cancer center.

OBJECTIVE: The purpose of this study was to estimate prevalence/severity of self-reported trismus, determine association with quality of life (QOL), and examine clinical risk factors in a large population of patients treated for oropharyngeal cancer. MATERIALS AND METHODS: A cross-sectional survivorship survey was conducted among patients who completed definitive treatment for oropharyngeal carcinoma, disease-free ≥ 1-year post-treatment (median survival, 7 years among 892 survivors). Associations between trismus and QOL were also analyzed using MDASI-HN, EQ-5D, and MDADI. Dietary and feeding tube status were also correlated to trismus status. RESULTS: Trismus was self-reported in 31%. Severity of trismus positively correlated (r = 0.29) with higher mean interference scores reflecting a moderate association with quality of life (p < 0.0001). There was a negative correlation for MDADI composite scores (r = - 0.33) indicating increased perceived dysphagia related to trismus severity (p < 0.0001). EQ-5D VAS scores were also negatively correlated with trismus severity (r = - 0.26, p < 0.0001). Larger T-stage (p ≤ 0.001), larger nodal stage (p = 0.03), tumor sub-site (p = 0.05), and concurrent chemoradiation (p = 0.01) associated with increased prevalence of trismus. Diet negatively correlated (r = - 0.27) with trismus severity (p = < 0.0001), and survivors with severe trismus were also more likely to be feeding tube-dependent. CONCLUSION: Severity of trismus appears to negatively impact quality of life and associate with various adverse functional outcomes in long-term oropharyngeal cancer survivorship. Trismus remains associated with advanced disease stages, tumor sub-site (tonsil), and addition of chemotherapy. Further investigation is merited for the dose-effect relationship to the muscles of mastication.

A Dosimetric Comparison of Oral Cavity Sparing in the Unilateral Treatment of Early Stage Tonsil Cancer: IMRT, IMPT, and Tongue-Deviating Oral Stents.

INTRODUCTION: Tongue-deviating oral stents (TDOS) are commonly used during unilateral neck radiation therapy to reduce unnecessary dose to nontarget oral structures. Their benefit in the setting of highly conformal treatment techniques, however, is not defined. The goal of this study was to investigate the potential benefit of TDOS use on dosimetric parameters in unilateral intensity modulated radiation therapy (IMRT) and intensity modulated proton therapy (IMPT). METHODS: A total of 16 patients with T1-2 tonsil cancer treated at a single institution were selected, of which 8 were simulated/treated with a TDOS and 8 without a TDOS. All received definitive unilateral IMRT to a dose of 66 Gy in 30 fx. IMPT plans were generated for each patient for study purposes and optimized according to standard institutional practice. RESULTS: For IMRT plans, the presence of a TDOS (vs without) was associated with a significantly lower oral mucosa mean dose (31.4 vs 35.3 Gy; P = .020) and V30 (42.7% vs 57.1%; P = .025). For IMPT plans, the presence of TDOS (vs without) was not associated with any improvement in oral mucosa mean dose (18.3 vs 19.9 Gy; P = .274) or V30 (25.0% vs 26.2%; P = .655). IMPT plans without TDOS compared with IMRT plans with TDOS demonstrated reduced oral mucosa mean dose (P < .001) and V30 (P < .001). CONCLUSION: The use of a TDOS for the unilateral treatment of well-lateralized tonsil cancers was associated with oral mucosa sparing for IMRT, but not for IMPT. Moreover, mucosa sparing was improved for IMPT plans without a TDOS compared to IMRT plans with a TDOS.

Head and neck surgical oncology in the time of a pandemic: Subsite-specific triage guidelines during the COVID-19 pandemic.

BACKGROUND: COVID-19 pandemic has strained human and material resources around the world. Practices in surgical oncology had to change in response to these resource limitations, triaging based on acuity, expected oncologic outcomes, availability of supportive resources, and safety of health care personnel. METHODS: The MD Anderson Head and Neck Surgery Treatment Guidelines Consortium devised the following to provide guidance on triaging head and neck cancer (HNC) surgeries based on multidisciplinary consensus. HNC subsites considered included aerodigestive tract mucosa, sinonasal, salivary, endocrine, cutaneous, and ocular. RECOMMENDATIONS: Each subsite is presented separately with disease-specific recommendations. Options for alternative treatment modalities are provided if surgical treatment needs to be deferred. CONCLUSION: These guidelines are intended to help clinicians caring for patients with HNC appropriately allocate resources during a health care crisis, such as the COVID-19 pandemic. We continue to advocate for individual consideration of cases in a multidisciplinary fashion based on individual patient circumstances and resource availability.

The multiple oral presentations of multiple myeloma.

PURPOSE: The purpose of this case series is to show the varied oral presentations of multiple myeloma, illustrating the importance of carefully surveying the oral cavity for suspicious lesions that could be indicative of palpable disease and/or recurrence. The diagnostic criteria and prognostic features for multiple myeloma were also reviewed. CASE SERIES SUMMARY: This report focuses on five patients with myeloma manifestations involving the oral cavity, in which the oral presentation of multiple myeloma was an early indication of disease relapse. Although the clinical presentation may be variable, the majority of patients will develop lytic bone lesions and less commonly, extramedullary involvement during the course of their disease. DISCUSSION: The presentation of myeloma can be varied and the oral presentation, although rare, may be the sole manifestation or part of a group of signs of disease progression. Clinical presentations of patients with myelomatous lesions can mimic common dental pathologies, which then, in turn, can lead to delays in diagnosis and treatment. CONCLUSION: As members of an interdisciplinary oncology team, it is essential to be familiar with oral manifestations of multiple myeloma and proper diagnostic/biopsy techniques in order to avoid misdiagnosis and treatment delays.

Survey of currently selected dental implants and restorations by prosthodontists.

PURPOSE: The purpose of this study was to survey the prosthodontists of the American College of Prosthodontists (ACP) and the American Academy of Maxillofacial Prosthetics (AAMP) to identify the most commonly used implant both during their training and currently in practice, and to evaluate overall restorative preference. Participants were asked to rank criteria that make an implant company desirable and important features when selecting an implant. MATERIALS AND METHODS: An electronic survey was emailed to 1,739 members of the ACP and AAMP. RESULTS: The majority of respondents (79%) were trained using Nobel Biocare brand implants, which was also the brand most often selected by participants for use in all regions of the oral cavity (34% to 39%, location dependent). Abutment preferences varied by area: incisors and canines (29%) and highly esthetic areas (53%) were more likely to be restored with custom milled zirconia abutments, while prefabricated titanium abutments were preferred for premolars and molar areas. Conventional loading was most often applied, ranging from 95% in medically compromised patients to 55% in esthetic areas. The majority of participants (86%) used Locator attachments for complete overdenture restorations. Also, respondents selected an implant company based on features and literature support versus cost and customer service. The implant features deemed most important were the design of the internal connection and ease of finding replacement parts; thread design and variety of abutments were deemed least important. Respondents reported that while implant planning software was used, they rarely/never order the concurrent surgical guide. CONCLUSION: Within the study's limitations, the majority of prosthodontists select implants based on training, features, and literature support.