Strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic.

During the current pandemic scenario, maxillofacial rehabilitation specialists involved with supportive care in cancer must transform its practice to cope with COVID-19 and improve protocols that could quickly return the oral function of complex cancer patients who cannot wait for surgical complex rehabilitation. This includes the role of the maxillofacial prosthodontist for the rehabilitation of surgically treated patients with maxillary cancers by the means of filling obturator prostheses that are considered an optimal scientific-based strategy to reduce hospital stay with excellent pain control, oral function (speech, swallowing, mastication, and facial esthetics), psychologic and quality of life outcomes for the patients following intraoral cancer resection. Therefore, the aim of this commentary was to bring new lights to the strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic as well as to present a protocol for managing such cases.

Avaliação da fala pré-tratamento e pós-tratamento fonoaudiológico associado ao biofeedback ultrassonográfico de língua e de prótese bucomaxilofacial no câncer de cavidade oral / Evaluation of speech before and after speech therapy associated with ultrasound biofeedback of tongue and bucomaxillofacial prosthesis in oral cavity cancer

RESUMO As próteses bucomaxilofaciais (PBMF) têm como objetivo a reabilitação oral de pacientes com mutilações decorrentes de cirurgias de câncer de boca. Como parte dessa reabilitação oral, a terapia fonoaudiológica associada ao biofeedback ultrassonográfico da língua possibilita melhor precisão da produção de fala. O presente estudo teve por objetivo caracterizar a produção de fala de um indivíduo com histórico de múltiplas cirurgias oncológicas que levaram à glossectomia total, com auxílio de um dispositivo individualizado de acrílico, idealizado a partir da parceria Odonto-Fonoaudiologia da instituição e confeccionado por especialista em PBMF e terapia fonoaudiológica, utilizando o biofeedback visual com ultrassonografia. O indivíduo era homem, 45 anos, professor aposentado com histórico de carcinoma epidermóide de língua com episódios de recidiva. Como tratamento oncológico, foram realizadas diversas cirurgias associadas à radioterapia, ao longo de sete anos. O tratamento oncológico culminou com a glossectomia total e instalação de osteorradionecrose de mandíbula. O tratamento desta sequela da radioterapia também exigiu múltiplas abordagens cirúrgicas, com perda de grande parte da mandíbula, levando ao severo comprometimento das funções de deglutição e fala. Durante o atendimento multiprofissional da equipe Odonto-Fonoaudiologia de um hospital universitário, foi idealizada a confecção de um dispositivo individualizado de acrílico, objetivando melhorar a inteligibilidade da fala do paciente. Tal dispositivo foi confeccionado por dentista especialista em PBMF e ajustado em conjunto com a equipe de Fonoaudiologia. Com o dispositivo de acrílico adaptado, o indivíduo iniciou a terapia fonoaudiológica associada ao biofeedback, por meio da ultrassonografia de língua, com o objetivo de promover o refinamento da produção de fala dos fones fricativos [s] e [∫]. Ao comparar a avaliação pré-terapia e pós-terapia, foi possível identificar, após a análise das falas por juízes, melhora quanto à Porcentagem de Consoantes Corretas, de moderadamente severa para levemente moderada, bem como a inteligibilidade de fala, de insuficiente para regular. O dispositivo individualizado com a terapia fonoaudiológica associada ao biofeedback produziram resultados de fala satisfatórios, considerando-se a gravidade do caso e o elevado grau de mutilação do paciente.

ABSTRACT The oral maxillofacial prostheses (PBMF) aim the oral rehabilitation of patients with mutilations resulting from oral cancer surgery. The oral rehabilitation was composed of speech therapy associated with ultrasound biofeedback of the tongue, which allows better precision in speech production. The present study aims to characterize the speech production of an individual with a history of multiple oncological surgeries with total glossectomy with the aid of an individualized acrylic device, designed based on the partnership between Dentistry and Speech Therapy and made by a prosthetic dentist, undergoing therapy and speech therapy with visual biofeedback by ultrasound. The individual is a 45-year-old man, retired teacher with a history of tongue squamous cell carcinoma with episodes of recurrence. The cancer treatment was performed by several surgeries associated with radiotherapy over seven years. This treatment resulted in total glossectomy and the presence of osteoradionecrosis (ORN) of the mandible. The sequel to radiotherapy also required multiple surgical approaches with loss of a large part of the jaw, causing severe impairment of swallowing and speech functions. During the multidisciplinary care provided by the Dentistry and Speech Therapy team at a university hospital. The creation of an individualized acrylic device was conceived, aiming to improve the speech intelligibility of the patient. This device was made by a prosthetic dentist and adjusted together with the Speech Therapy team. With the adapted acrylic device, the individual started speech therapy associated with biofeedback by means of tongue ultrasound with the aim of promoting the refinement of the speech production of the fricative headphones [s] and [∫]. When comparing the pre-therapy and post-therapy assessment (after the analysis of the speeches by judges) it was possible to identify an improvement in the Percentage of Consonants Correct (PCC) from moderately-severe to slightly-moderate, as well as speech intelligibility from insufficient to regulate. The individualized device with speech therapy associated with biofeedback produced satisfactory speech results, considering the severity of the case and the high degree of mutilation of the patient.

Optimizing survival of large fibula osteocutaneous flaps for extensive full-thickness oromandibular defects: A two-stage approach with temporary orocutaneous fistula.

INTRODUCTION: Composite and large head and neck defects requiring extensive skin-mucosa coverage are often reconstructed by combining flaps. Herein, we present a simple and reliable two-stage fibula osteocutaneous (FOC) flap technique to improve the survival of a large skin paddle for oromandibular reconstructions. METHODS: From October 2011 to September 2016, 47 patients with through-and-through oromandibular defects were reconstructed using FOC flaps with large skin paddles. To ensure optimum survival of skin paddles, temporary orocutaneous fistula were left in place and closed during the second stage operation via de-epithelialization of the skin paddle and suturing of mucosa. Demographic data, operative details, and postoperative complications were recorded. RESULTS: The skin paddle dimensions ranged from 20 to 31.5 cm in length and 12 to 17 cm in width with an average area of 430.4 cm2 (range 300-504). The average time between the two stages and hospital stay were 10 days and 14 days, respectively. Complications at the donor site included wound dehiscence (n = 3, 6.4%), partial skin graft loss (n = 3, 6.4%) and hematoma (n = 2, 4.3%). Recipient site complications included two (4.3%) early postoperative venous congestions that resolved after elevation and three (6.4%) partial skin flap necrosis (less than 5% surface area). All complications resolved with bedside conservative management. There was only one take-back for evacuation of recipient site hematoma (2.1%) but no flap loss. CONCLUSION: Two-staged large skin paddle FOC flaps can simplify reconstruction of extensive oromandibular defects by improving the reliability of the sizable skin paddle and negating the need for a second flap.

The association of variables of fibular reconstructed mandible and bite force in oral cancer patients with dental implant rehabilitation.

PURPOSE: The aim of this study was to investigate how the physical variables of fibular reconstructed mandibles with dental implants affects the relative bite force in oral cancer patients. MATERIALS AND METHODS: Over 7 years of follow-up, 13 oral cancer patients were enrolled who included 51 successful implants in the fibular flap. The tactile sensor analyzer evaluated the bite force. The crown-implant ratio, fibular, and rehabilitated dental length were measured using radiographic images. Linear regression was used to analyze the bite force related to the variables of the implants in the fibular reconstructed mandible. RESULTS: Even when the results showed no statistical significance (P > 0.05), increasing the crown-implant ratio, length of the fibular flap, and implant prosthetic reconstructed dentition had a tendency to decrease the bite force (estimate from -0.08% to -4.27%); there was a positive trend of occlusal force and the length of rehabilitative dentition compared with the dental antagonist (estimate = 6.95). CONCLUSION: In this study, the crown-implant ratio, implant dentition, and fibular flap length revealed no significant impact on the bite force or implant success in oral cancer patients; however, a trend to weaken the bite force was suggested once the numerical values of these variables increased.

Framework for Speech-Language Pathology Services in Patients with Oral Cavity and Oropharyngeal Cancers.

This article provides a framework speech-language pathology services to optimize functional outcomes of patients with oral cavity and oropharyngeal cancers. Key principles include (1) a proactive rehabilitation model that minimizes intervals of disuse or inactivity of speech and swallowing systems, (2) standardized evaluation paradigms that combine objective instrumental assessments with patient-reported outcome measures, and (3) systematic methods for surveillance and intensive rehabilitation for late dysphagia.

Long-term results of osseointegrated implant-based dental rehabilitation in oncology patients reconstructed with a fibula free flap.

BACKGROUND: Dental rehabilitation with conventional prostheses after microvascular jaw reconstruction is often unsuccessful because of the altered oral anatomy and the lack of adequate dentition for fixation. PURPOSE: This retrospective study evaluated the long-term outcomes of patients who underwent jaws reconstruction with a fibula free flap and subsequent rehabilitation with implant-supported prostheses. MATERIALS AND METHODS: In total, 21 patients were enrolled; 108 osseointegrated dental implants, positioned on 21 fibular free flaps were assessed. Follow-up examinations were performed according to a standardized protocol, including clinical and radiological evaluations. The mean follow-up after implant insertion was 90.2 (range, 20-204) months. RESULTS: The overall implant survival rate was 97.2% at the 12-month follow-up, 86.5% at 60 months, and 79.3% at 120 months. The rate of overall implant success was 95.4% at the 12-month follow-up, 73.5% at 60 months, and 64.7% at 120 months. Implant failure was more common in patients that had implants placed after they underwent radiation therapy. Peri-implantitis and mucositis were identified in 14.8% and 20.3% of surviving implants, respectively, at the 5- and 10-year follow-up. The risk of developing peri-implantitis was estimated to be higher (odds ratio = 1.5) for patients without connective tissue or skin grafts versus patients with one of them (18.2% vs 9.5%). CONCLUSIONS: Long-term implant-related outcomes show that the survival rate of implants placed into the fibula is acceptable. Radiotherapy negatively impacts survival and success, in particular in the short and medium-term follow-up. Moreover, a relevant peri-implant bone resorption does occur over time and ultimately influences implants success, and it is mainly related to peri-implant gingival mucositis. In this regard skin or connective tissue grafts seem to offer an aid to manage this problem.

Early intensive rehabilitation after oral cancer treatment.

PURPOSE: The treatment of oral cancer requires an effective rehabilitation strategy such as an early intensive rehabilitation (EIR) program. MATERIALS AND METHODS: The medical records and data of 41 patients who participated in an EIR program and 20 control group patients were analyzed. These patients all underwent surgical resection of the primary tumor followed by microsurgical reconstruction using free flaps. The length of stay (LOS) at the acute care hospital was compared between the two groups. Four indexes were used to evaluate the effectiveness of the EIR program. RESULTS: EIR patients stayed an average of 11.6 fewer days at the acute care hospital. All indexes showed significant improvements (p < 0.001). The Barthel Index (BI) and the Early Intensive Rehabilitation Barthel Index (EIR-BI) improved by 36.0 and 103.6 points, respectively. At discharge, the Bogenhausener Dysphagia Score (BODS) had improved to a score of 11.0 compared to the 13.9 at admission. EIR patients had a Work Ability Index (WAI) score of 25.7. CONCLUSION: Length of stay at the acute care hospital can be reduced using early intensive rehabilitation if patients are transferred to an intensive rehabilitation clinic early.

Oral rehabilitation of the cancer patient: A formidable challenge.

Rehabilitation of oral functions following surgery on the jaws is a goal that is often difficult to achieve. Removable dentures supported by remaining teeth or gum are often unstable and seldom satisfactory. On the other hand, endosseous (dental) implants offer a mechanism to provide stability to the dentures. This review, discusses factors related to the tumor, patient, treatment, and physicians which impact upon the feasibility and success of dental implants in patients with oral cancer.

The use of dental implants, cast bars and sleeve overdentures in oral cancer patients.

Surgical resection of an oral tumour (and the associated free flap reconstruction) can significantly alter the oral anatomy. The lack of sulcus depth, alveolar ridge, presence of a mobile flap and limited tongue movement can make it impossible for patients to control a removable prosthesis. To help this cohort of patients, dental implants can be invaluable. The Oral Rehabilitation Team at Central Manchester University Dental Hospital have used dental implants to rehabilitate oral cancer patients for over thirty years. After their resective surgery, a number of patients were dentally rehabilitated with a laboratory-made, precious metal-alloy bar supported by at least four dental implants. A metal-alloy under-sleeve retained overdenture was then provided to fit over the milled bar. The majority of the 50 patients in this case series had tumours in the anterior floor of the mouth. It was noted that 76% of the patients received a rim resection and were reconstructed with a fasciocutaneous, soft tissue free flap. Six percent of patients received a segmental resection and were reconstructed with either a fibular or deep circumflex iliac artery free flap. The dental implants and sleeve overdentures had a survival rate of 100%. None of the dentures lost retention, implying that the frictional grip between the overcasting and the milled bar was sufficient to appease the retention demands of this cohort. However, 10% of patients encountered complications. This would suggest a success (or complication free) rate of 90% for this cohort of 50 oncology patients. This would still imply that milled bars/sleeve overdentures carry a relatively low maintenance burden and may be a useful treatment option for oral cancer patients.

Evaluation of swallowing ability using swallowing sounds in maxillectomy patients.

Maxillectomy for oral tumours often results in debilitating oral hypofunction, which markedly decreases quality of life. Dysphagia, in particular, is one of the most serious problems following maxillectomy. This study used swallowing sounds as a simple evaluation method to evaluate swallowing ability in maxillectomy patients with and without their obturator prosthesis placed. Twenty-seven maxillectomy patients (15 men, 12 women; mean age 66.0 ± 12.1 years) and 30 healthy controls (14 men, 16 women; mean age 44.9 ± 21.3 years) were recruited for this study. Participants were asked to swallow 4 mL of water, and swallowing sounds were recorded using a throat microphone. Duration of the acoustic signal and duration of peak intensity (DPI) were measured. Duration of peak intensity was significantly longer in maxillectomy patients without their obturator than with it (P < .05) and was significantly longer in maxillectomy patients without their obturator than in healthy controls (P < .025 after Bonferroni correction). With the obturator placed, DPI was significantly longer in maxillectomy patients who had undergone soft palate resection than in those who had not (P < .05). These results suggest swallowing ability in maxillectomy patients could be improved by wearing an obturator prosthesis, particularly during the oral stage. However, it is difficult to improve the oral stage of swallowing in patients who have undergone soft palate resection even with obturator placement.

Restorative dentistry and oral rehabilitation: United Kingdom National Multidisciplinary Guidelines.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK and provides recommendations on the pre-treatment oral and dental assessment, during and after treatment and oral rehabilitation. Restorative dentists are core members of the multidisciplinary team treating head and neck cancer patients, involved from the treatment planning phase through to long-term rehabilitation. Recommendations • Preventative oral care must be delivered to patients whose cancer treatment will affect the oral cavity, jaws, salivary glands and oral accessibility. (G) • Close working and communication between the surgeons, oncologists and restorative dental specialists is important in ensuring optimal oral health outcomes. (G) • Intensity-modulated radiotherapy has been shown to reduce long-term xerostomia and should be offered to all appropriate patients. (R) • If patients are deemed at risk of trismus they should be warned and its progressive and potentially irreversible nature explained. (G) • Where it is known that adjuvant radiotherapy will be given, extractions should take place at primary surgery to maximise the time for healing and minimise the number of surgical events for patients. (G) • Osseointegrated implants should be considered for all patients having resection for head and neck cancer. (G).

Prosthetic Rehabilitation After Fibular Free Flap Surgery of Mandibular Defects in a Patient With Oral Squamous Cell Carcinoma.

OBJECTIVE: This report is to present the treatment procedure and clinical considerations of prosthodontic management of a patient who had undergone a partial mandibulectomy and fibular free flap surgery. DESIGN: A 59-year-old man with a squamous cell carcinoma received a partial mandibular resection. Microsurgical reconstruction with a fibular free flap surgery and implant-supported zirconia-fixed prosthesis produced by computer-aided manufacturing led to successful results for the oral rehabilitation of mandibular defects. CONCLUSIONS: The implant-supported zirconia-fixed prosthesis can be recommended for use in patients with mandibulectomy and fibular free flaps. Close cooperation between the surgeon and the prosthodontist is mandatory for the satisfaction of the patient.

Postradiotherapy Dental Implant Insertion Into Bone Grafts Harvested From Nonirradiated Tissue: Case Reports.

BACKGROUND: Prostheses and dental implants are often used to aid oral rehabilitation after surgery (with/without radiotherapy) for oral cancer. However, some studies have reported that the insertion of dental implants into irradiated bone results in a higher frequency of implant failure than the insertion of such implants in nonirradiated bone. MATERIALS AND METHODS: This report describes the cases of 4 patients with oral cancer who underwent surgery and radiotherapy (total dose: 50-86 Gy) and then had dental implants inserted within the irradiated area. In each case, an ilium bone graft or a latissimus dorsi myocutaneous flap containing scapular bone was transferred to the dental implant site before the insertion of the implants. RESULTS: Twenty-three implants were inserted. After loading, 2 implants were lost, and 21 remained stable. CONCLUSION: In patients who have undergone radiotherapy for oral cancer, transferring bone grafts harvested from nonirradiated tissue to the irradiated site before implant insertion might help to improve dental implant survival rates.

Among Patients Undergoing Ablative Treatment for Oral Cancer, Does the Provision of Oral Rehabilitation Improve the Quality of Life? A Review of the Current Literature.

PURPOSE: The impact of oral cancer and its treatment is well documented; therefore, oral rehabilitation (OH; eg, with prosthetics, osseointegrated implants, etc) can be indicated to restore some level of form, function, and well-being. The purpose of this study was to review the current literature and evaluate the impact of OH on quality of life (QoL) after ablative surgery. MATERIALS AND METHODS: A systematic literature search was conducted using EMBASE, MEDLINE, and PsychINFO. The study population was composed of all articles published from 2000 to 2015. To be included, studies had to use validated, specific head and neck QoL measurements (European Organization for Research and Treatment of Cancer QoL Head and Neck Module or University of Washington QoL Questionnaire). Only 8 articles met these inclusion criteria. In this review, OH was the primary predictor variable and QoL was the primary outcome variable. RESULTS: The 8 articles reviewed used a range of designs, including 1 randomized controlled trial, 3 prospective cohort studies, 3 case series, and 1 single-measurement cross-sectional descriptive study. Sample sizes were small (n = 26 to 102), and there was limited randomization and control of intervention and comparator groups. The overall level of evidence was weak. All studies showed a link between OH and QoL, but the results varied in significance (P < .01 to P = .95). CONCLUSION: Overall, there appears to be improvement in QoL to varying degrees after OH. However, a more systematic use of QoL measurements is needed before any definitive conclusions can be drawn.

Oral health-related quality of life after prosthetic rehabilitation in patients with oral cancer: A longitudinal study with the Liverpool Oral Rehabilitation Questionnaire version 3 and Oral Health Impact Profile-14 questionnaire.

BACKGROUND: Prosthodontic rehabilitation helps to improve the oral health-related quality of life (OHRQOL). The Liverpool Oral Rehabilitation Questionnaire (LORQ) and Oral Health Impact Profile (OHIP) are specific tools that measure OHRQOL. OBJECTIVE: The primary objective of this study was to assess the impact of oral rehabilitation on patients' OHRQOL following treatment for cancer of oral cavity using LORQ version 3 (LORQv3) and OHIP-14 questionnaire. Secondary objectives were to identify issues specific to oral rehabilitation, patients compliance to prosthetic rehabilitation, the effect of radiation treatment on prosthetic rehabilitation, to achieve meaningful differences over a time before & after prosthetic intervention, to carryout and document specific patient-deprived problem. METHODOLOGY: Seventy-five oral cancer patients were studied. Patients were asked to rate their experience of dental problems before fabrication of prosthesis and after 1 year using LORQv3 and OHIP-14. The responses were compared on Likert scale. RESULTS: Patients reported with extreme problems before rehabilitation. After 1 year of prosthetic rehabilitation, there was improvement noticed in all the domain of LORQv3 and OHIP-14. Complete compliance to the use of prosthetic appliances for 1 year study period was noted. In response to the question no. 40 (LORQv3), only 15 patients who belonged to the obturator group, brought to notice the problems which were not addressed in the LORQv3 questionnaire. CONCLUSION: The study showed that the oral cancer patients coped well and adapted to near normal oral status after prosthetic rehabilitation. This contributed to the improved overall health-related quality of life.

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.

Supportive care needs of oral cancer survivors: Prevalence and correlates.

OBJECTIVES: Many cancer survivors experience unmet supportive care needs. The oral cancer survivor population is growing; however, little is known about the unique needs of this group. The present study aimed to determine the supportive care needs of persons with oral cancer who had completed active treatment at least three months previously. MATERIALS AND METHODS: Oral cancer survivors (N=342) completed an online questionnaire that included the validated Survivors Unmet Needs Survey (SUNS). Relationships between SUNS subscales and various demographic, clinical, and psychosocial variables were examined in univariate and multivariate analyses. Survivors also indicated their top unmet needs and interest in supportive care services. RESULTS: Survivors reported substantial unmet needs across all domains, with many of the top unmet needs falling in the emotional domain. Poorer mental and physical health were associated with greater unmet needs across all domains. In each domain, select demographic and clinical variables also were associated with greater unmet needs in univariate and multivariate analyses. Survivors reported high rates of interest in several supportive care services including support groups and various forms of informational support. CONCLUSION: The present study highlights the significant burden of unmet supportive care needs in oral cancer survivors who have completed treatment and are coping with long-term ramifications of the disease and its treatment, reveals factors related to those needs, outlines these survivors' interest in a range of supportive care services, and suggests future research directions.

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.

Evaluation of Highly Porous Dental Implants in Postablative Oral and Maxillofacial Cancer Patients: A Prospective Pilot Clinical Case Series Report.

PURPOSE: The aim of this study was to evaluate the clinical efficacy of new porous tantalum trabecular metal (PTTM)-enhanced titanium dental implants used for the prosthodontic rehabilitation of postablative cancer patients. First-year interim results of a prospective clinical case series are presented. MATERIALS AND METHODS: A total of 25 PTTM-enhanced titanium implants were placed in both maxillas and mandibles of 6 patients, who met specific inclusion criteria. Resonance frequency analysis was conducted, and implant stability was recorded in Implant Stability Quotient (ISQ) values at implant placement and after 2, 4, 6, and 12 months of functional loading. Bone levels were calculated by digitally measuring the distance from the implant shoulder to the first bone-to-implant on periapical radiographs taken at surgery and after 2, 4, 6, and 12 months of functioning. RESULTS: Cumulative implant survival was 100% (n = 25/25). At implant placement and the 2-, 4-, 6- and 12-month monitoring appointments, mean ISQ values were 72.14 ± 5.61 (range = 50-81), 64.39 ± 8.12 (range = 44-74), 74.26 ± 7.14 (range = 44-74), 76.84 ± 7.65 (range = 60-83), and 78.13 ± 4.14 (range = 64-84), respectively, and mean crestal marginal bone loss was 0.19 ± 0.25, 0.22 ± 0.4, 0.3 ± 0.46, and 0.57 ± 0.62 mm, respectively. CONCLUSIONS: PTTM-enhanced dental implants were clinically effective in the prosthetic rehabilitation of postoncological patients. Larger long-term follow-up studies will help to evaluate clinical efficacy of PTTM dental implants.