Oral health and oral health-related quality of life in patients with oral dystonia indicates their need for dental special care.

BACKGROUND: This retrospective study aimed in the evaluation of oral health and oral health-related quality of life (OHRQoL) of patients with oral dystonia (OD). MATERIAL AND METHODS: Seventeen patients with OD (Meige Syndrome: n=11, Oromandibular Dystonia: n=6) were included, of which seven were examined again at three months after botulinum toxin injection. OHRQoL was assessed by the German short form of oral health impact profile (OHIP G14). Within oral examination, dental parameters, remaining teeth and periodontitis severity were assessed. A matched healthy control (HC) was composed for comparison. RESULTS: The OD patients had significantly more carious teeth (0.94 ± 1.75 vs. 0; p<0.01), less remaining teeth (15.65 ± 9.89 vs. 22.22 ± 5.91; p=0.01) and higher dental treatment need than the HC (42.9% vs. 0%; p<0.01). The OHIP G14 sum score of 9.47± 9.82 vs. 1.58 ± 2.79 (p<0.01) as well its dimensions psychosocial impact (4.47 ± 6.45 vs. 0.53 ± 1.16; p=0.03) and oral function (4.35 ± 2.98 vs. 0.47 ± 1.34; p<0.01) were clinically relevant and statistically significant higher in OD compared to HC group. No significant differences could be detected at three months after botulinum toxin injection. CONCLUSIONS: Patients with OD suffer from more dental diseases and have a worse OHRQoL than HC. Dental special care appears recommendable and should be fostered by everyone, who is involved in the treatment of patients with OD.

Shallow whole genome sequencing of adenoid cystic carcinomas of the salivary glands identifies specific chromosomal aberrations related to tumor progression.

BACKGROUND AND PURPOSE: Adenoid cystic carcinomas (ACC) are characterized by high rate of local recurrence and late distant metastasis. Chromosomal changes in the evolution from primary tumors to metastatic disease of ACC have not been appointed. Here we investigated the chromosomal alterations of 53 primary tumors from ACC patients with different progressive states by shallow whole genome sequencing to identify potential new markers for metastatic spread. METHODS: Illumina paired-end libraries were generated using DNA from the primary tumor of 53 ACC patients. Fragmented DNA was end-repaired, A-tailed and multiplex sequencing adapters were ligated. Sequence data were mapped to HG19 and a copy-number analysis was conducted using the QDNAseq R package (version 1.10.0). Outliers were removed and data was smoothed by applying the circular binary segmentation algorithm implemented in the R package copynumber version 1.22.0. A modified chromosomal instability (CNI) score was used to analyze deletions and amplifications. RESULTS: Cluster analysis of the whole genome sequencing revealed that the frequency of chromosomal aberrations were increased in ACC with local recurrence and distant metastases in comparison to ACC patients with no metastatic spread. Specifically, chromosome 6 and 12 and exclusively the entire chromosome 4 showed an increased frequency of chromosomal alterations with tumor progression. CONCLUSION: Our data show a molecular evolution from primary tumors to local recurrences and distant metastases and pinpoint the critical chromosomal regions involved in this process. These regions should be in the focus of the search for therapeutic targets of progressive ACC.

[Botulinum toxin in otorhinolaryngology - an update]. / Botulinumtoxin in der HNO­Heilkunde ­ ein Update.

During recent decades, the clinical use of botulinum toxin has become increasingly well established. In the field of otorhinolaryngology there are many indications for which botulinum toxin can improve patients' quality of life. These include applications in the region of the head and neck muscles and the autonomic nervous system in patients suffering from movement disorders of special muscles and secretory disorders (salivary, lacrimal, and sweat glands). The present article presents an overview of well-established and new indications for application of botulinum toxin in the head and neck region.

Deep neck infections: A single-center analysis of 63 cases.

BACKGROUND AND PURPOSE: With the use of antibiotic therapy, the incidence of deep neck infections has decreased in recent decades. The aim of this investigation was to review the clinical course and the management of deep neck infections in our department, compare them to the experiences of the common literature and identify predisposing factors for lethal complications. MATERIAL AND METHODS: In this single-center analysis, 63 patients with deep neck infections were treated surgically. The following clinical data were analyzed and compared: age, gender, laboratory data, spatial manifestation, therapeutic modalities, comorbidities, length of hospitalization and complications. RESULTS: There was a predominance of male patients (58.7%) and a mean age of 57.9 years. The most common symptoms at diagnosis were sore throat (96.8%) and neck swelling (92.0%). Cardio/pulmonary diseases and diabetes mellitus were the most common comorbidities. There was a significantly longer hospital stay for patients with diabetes mellitus. The most common manifestation was a parapharyngeal abscess in 24 patients (38.1%), followed by peri-/retrotonsillar infections in 19 patients (30.2%). In 29 patients, a multiple space infection was observed, with a significantly longer duration of hospitalization and a higher rate of complications. The main life-threatening complication was the development of airway obstruction in 20 patients (31.7%), who all received a tracheostomy. The duration of hospitalization for patients with complications was significantly longer. CONCLUSION: Close attention must be paid to the management of patients with deep neck infections, especially patients with diabetes mellitus and cardio/pulmonary diseases or patients with multiple space infections.

[Changes in dose and injection pattern in the botulinum toxin long-term therapy of facial dyskinesis]. / Änderung von Dosis und Injektionsmuster der Botulinumtoxin-Langzeittherapie fazialer Dyskinesien.

BACKGROUND: Rare information exists about comparative long-term observations of patients with facial movement disorders. This retrospective analysis deals with the course of different parameters of injection over the time. METHODS: In this study we compared the development of long-term botulinum toxin treatments of patients with blepharospasm, hemifacial spasm and synkinesis. 80 patients (n=30 blepharospasm, n=31 hemifacial spasm, n=19 synkinesis), who had at least 10 consultations for BTA-injections, were included in the retrospective analysis. The development for each entity in total dosage, increase in the number of injection points and change in dosages for each point were evaluated. RESULTS: The over-all dosage in all 3 clinical disorders and for each single disease itself increased continuously over the time. The amount of injection points increased in the treatment of hemifacial spasm and synkinesis. The dosage per point increased most in blepharospasm between the 1. and 25. injection, but was distinctly lower in patients with hemifacial spasm and synkinesis. The increase in dosage in blepharospasm is therefore, in contrast to the other indications, mostly caused by an increase in dosage per point. In patients with hemifacial spasm and synkinesis the escalation of dosage is mainly caused by an increase of the number of injection points. CONCLUSION: These new aspects of the dynamic in the treatment with botulinum toxin enable the physician to understand better the dynamic of these diseases, to optimize treatment protocols.

[Rhinorrhea following laryngectomy : Treatment with botulinum toxin type A.] / Rhinorrhoe nach Laryngektomie : Behandlung mit Botulinumtoxin Typ A.

After laryngectomy, the transport of intranasal secretions is often inadequate due to the lack of the nasal ventilation. Consequently, persistent and disruptive anterior rhinorrhea may occur. We report the case of a 61-year-old man who had recently undergone a laryngectomy and who was successfully treated with bilateral injections of botulinum toxin into the anterior portion of the inferior turbinates. After treatment, rhinorrhea was clearly reduced. Therefore, symptomatic treatment of anterior rhinorrhea with local injections of botulinum toxin type A should be considered as an option to improve the quality of life in laryngectomized patients.

[Hypersalivation - inauguration of the S2k Guideline (AWMF) in short form]. / Hypersalivation - Ersterstellung der S2k-Leitlinie (AWMF) in gekürzter Darstellung.

Hypersalivation describes a relatively excessive salivary flow, which wets the patient himself and his surroundings. It may result because of insufficient oro-motor function, dysphagia, decreased central control and coordination. This reduces social interaction chances and burdens daily care. Multidisciplinary diagnostic and treatment evaluation is recommended already at early stage and focus on dysphagia, and saliva aspiration. Therefore, a multidisciplinary S2k guideline was developed. Diagnostic tools such as fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing studies generate important data on therapy selection and control. Especially traumatic and oncologic cases profit from swallowing therapy programmes in order to activate compensation mechanisms. In children with hypotonic oral muscles, oralstimulation plates can induce a relevant symptom release because of the improved lip closure. In acute hypersalivation, the pharmacologic treatment with glycopyrrolate and scopolamine in various applications is useful but its value in long-term usage critical. The injection of botulinum toxin into the salivary glands has shown safe and effective results with long lasting saliva reduction. Surgical treatment should be reserved for isolated cases. External radiation is judged as ultima ratio. Therapy effects and symptom severity has to be followed, especially in neurodegenerative cases. The resulting xerostomia should be critically evaluated by the responsible physician regarding oral and dental hygiene.

[Botulinum toxin for the treatment of spastic entropion. Case report]. / Botulinumtoxintherapie beim spastischen Entropium. Fallbericht.

Spastic entropion is a rare condition that predominantly affects older people. We report on a 74-year-old dementia patient who was successfully treated by botulinum toxin injections into the lower eyelid, thereby avoiding lid correction surgery. For patients with an increased risk of eyelid surgery, symptomatic therapy comprising botulinum toxin injections to the lower eyelid should be considered as an alternative treatment.

[The application of botulinum toxin in oromandibular, pharyngeal and laryngeal dystonia]. / Zur oromandibulären, pharyngealen und laryngealen Anwendung von Botulinumtoxin.

Dystonias of the oral, pharyngeal and laryngeal muscles are potential causes of deglutitive, respiratory and communicative disorders. In addition to functional deficits such as dysphagia, dysarthria and dysphonia, social disadvantages may arise from the visible or audible manifestations. Treatment with botulinum toxin offers symptomatic and temporary therapeutic effects. Examples of applications in oromandibular dystonia, palatoclonus, dysphagia and laryngeal dystonia (e.g., spasmodic dysphonia) are described.

[Treatment of blepharospasm, hemifacial spasm and facial synkinesis with botulinum toxin]. / Anwendung von Botulinumtoxin beim Blepharospasmus, Spasmus facialis und bei Synkinesien nach Fazialisdefektheilung.

Involuntary facial movements are caused by various diseases. This article describes three of these diseases: blepharospasm, hemifacial spasm and facial synkinesis following facial nerve paralysis. The different etiologies, clinical symptoms and diagnosis are discussed. A common therapeutic approach for these three diseases is presented. Involuntary facial movements can be reduced or even completely suppressed by local injections of botulinum toxin.

[Botulinum toxin to treat sweat caused sequelae in patients with hearing aids, active middle ear implants and cochlear implants]. / Regulierung der periaurikulären Schweissproduktion durch Botulinumtoxin A zur Sicherung von Funktion und Tragekomfort von Hörgeräten, Mittelohr- und Cochleaimplantaten.

The production of sweat in the temporal skin region may be a serious problem for patients with hearing aids, active middle ear implants or cochlear implants. We report on two patients suffering from a loss of function of their hearing aid and a reduction of the "wear comfort" of an active middle ear implant. The patients underwent intracutaneous botulinum toxin (BTX) treatment of the temporal skin region. In both patients a distinct improvement of their complaints occurred, enabling them to use their hearing aids and active middle ear implants continuously. BTX injections are suited to improve sweat-caused complaints in patients with hearing aids, active middle ear implants and cochlear implants.

[Botulinum toxin A after microvascular ALT flap in a patient with (corrected) squamous cell carcinoma of the tongue]. / Botulinumtoxin A gegen Hypersalivation. Einsatz bei Wundheilung nach Resektion eines Zungenkarzinoms.

We report the case of a 23-year-old man presenting with a cT4 cN1 M0squamous cell carcinoma of the right tongue. After tumor resection and covering of the defect with a microvascular anterolateral thigh (ALT) flap, the patient showed distinct drooling without any substantial regression after anticholinergic therapy. For this reason 75 units of Botox® were injected into the submandibular and parotid glands. After the intraglandular injections, good reduction of saliva secretion was achieved. The treatment improved flap healing, aspiration and patient satisfaction. Injection of botulinum toxin A into the salivary glands is a sufficient therapy for postoperative hypersalivation.

[Use of botulinum toxin in ORL departments in Germany]. / Verwendung von Botulinumtoxin an HNO-Kliniken in Deutschland.

BACKGROUND: There are no regional data about the prevalence and use of botulinum toxin (BoNT) in otorhinolaryngology (ORL) departments in Germany. In order to obtain an overview of the current applications of BoNT in ORL departments a survey was carried out. MATERIALS AND METHODS: Standardized multi-choice questionnaires were mailed to 150 ORL departments. In the analysis a differentiation was made between university and regional departments. Also an analysis of the whole collective of respondent hospitals was carried out. The most commonly treated indication is the Frey syndrome followed by hypersalivation due to a salivary fistula after parotidectomy, dysphagia, aesthetic application and laryngeal dystonia. RESULTS: The rate of return was 62% and 75% of all responding hospitals use BoNT as a therapeutic option, especially where "off-label-use" indications are concerned (15 out of 20 indications or 75%). DISCUSSION: BoNT is widely used as a therapeutic option with an increasing trend. Due to different applications a schedule of hospitals would be helpful in order to be able to find the nearest hospital for the appropriate indications.

[Radiotherapy : an option for refractory salivary fistulas]. / Radiatio : Therapieoption bei therapierefraktärer Speichelfistel.

A 45-year-old patient presented with refractory salivary fistula, attributed to multiple surgery and Botulinum toxin, following lateral parotidectomy. He underwent fractionated radiotherapy of the remaining parotid gland including the fistula opening (total dose of 30 Gy) at our clinic. In time, fistula secretion could be inhibited completely. Although the indication for radiotherapy for such fistulas is rare since Botulinum toxin has been in use, it should still be considered in refractory disease courses.

[Botulinum toxin treatment in the head and neck region: current aspects, developments, and problems]. / Botulinumtoxin-Therapie im Kopf-Hals-Bereich : Aktuelle Aspekte, Entwicklungen und Probleme.

Some interesting developments, aspects, and problems concerning botulinum toxin treatment of disorders of the head and neck region have recently been reported. These new approaches are discussed in this review. They include applications into mimic muscles (prevention of scar formation, treatment of depressions), into laryngeal muscles, and into the upper esophagus. In addition, treatment of different forms of headache and tinnitus as well as applications in the autonomic nervous system are addressed. Some of these options will shortly be put into clinical use, while others have to be checked further in clinical studies.

[Solitary intraparotid neurofibroma of the facial nerve. Symptomatology, biology and management]. / Das solitäre intraparotideale Neurofibrom des N. facialis. Symptomatik, Biologie und Management.

Neurogenic neoplasms of the parotid gland are extremely uncommon. We present the case of a solitary intraparotid neurofibroma of the N. facialis occurring in a 55-year-old female who noted a painless left-side enlargement in the region of the parotid gland over a period of 2 years. Facial function was normal. Magnetic resonance imaging revealed a well-demarcated round mass within the left parotid. At surgery, a tumor was found involving the main trunk of the facial nerve, histopathologically representing a neurofibroma. Since solitary intraparotid neurofibromas are characterized by a very slow growth lacking the propensity for malignant transformation, the tumor was left to preserve facial nerve function. The clinical course over months or even years and the non-specific symptomatology are characteristic of intraparotid facial neurofibromas. Surgical management depends on the clinical setting in the individual case. Conservative treatment based on facial nerve preservation and leaving the tumor in situ is recommended, rather than radical tumor removal with resection of the segment of the N. facialis involved.

Inflammatory diseases of the salivary glands in infants and adolescents.

OBJECTIVE: To determine retrospectively the localization, etiology and treatment of inflammatory diseases of the salivary glands in infants and children and to evaluate treatment outcome. PATIENTS AND METHODS: Forty-five patients were treated in our institution in the period 1966-2000. The patients' records were evaluated and the results and side-effects of therapy were documented by a controlled follow-up study. RESULTS: Twenty-five of our patients were females (55.6%) and 20 males (44.4%). Inflammatory disorders figured most prominently in the group of patients between 12 and 16 years (n=14). Inflammation of the submandibular glands was the most common disease with 53.3% (n=24). The most frequent underlying cause in this subgroup of acute and chronic sialadenitis was sialolithiasis of the submandibular gland (40%). All patients were symptom-free in the long-term follow-up and all were symptom-free after surgical intervention. CONCLUSIONS: The present study shows that diseases of the salivary glands are rare among infants and children. Acute and chronic sialadenitis not responding to conservative treatment requires an appropriate surgical approach.