Prevalence of Trismus and Its Impact on Oral Health-Related Quality of Life in Patients Treated for Oral Squamous Cell Carcinoma.

Oral squamous cell carcinoma, one of the most common malignancies, has a poor prognosis due to impairment in oral functions secondary to treatment. Trismus one of the major causes of impairment of oral function. The present study investigated the prevalence of trismus and its impact on oral health-related quality of life (OHRQoL) in patients treated for oral squamous cell carcinoma (OSCC). The maximum inter-incisal mouth opening of hundred OSCC patients was recorded at post-treatment and 3 months post-treatment. OHRQoL questionnaire (OHIP-14) was intervened to assess the OHRQoL of patients post-treatment and 3 months follow-up, with emphasis on correlation with grades of trismus. The prevalence of trismus was 16% pre-treatment, 72% post-treatment, and 62% at 3 months after treatment. The overall OHIP-14 scores indicated that patients with trismus reported greater impairment of OHRQoL than those without trismus at the end of treatment and 3 months follow-up. At the end of treatment, patients with severe trismus demonstrated a higher mean OHIP-14 score (23.47 ±3.34) than those with moderate (17.72 ±2.83) and mild trismus (12.66 ±3.84) with statistically significant differences (p <0.001). Equivalent results were obtained at 3 months follow-up period. Patients with trismus suffer greater impairment of OHRQoL. The findings demand the need of identifying risk factors for developing trismus and early institution of newer/modified treatment approaches for better OHRQoL in OSCC survivors.
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Oral and general health-related quality of life in oral squamous cell carcinoma patients- comparative analysis of different treatment regims.

BACKGROUND: Modern aggressive oncological treatment options for oral squamous cell carcinoma (OSCC) are inevitably associated with impaired general health-related quality of life (HRQoL) and oral HRQoL (OHRQoL). However, there is dire need for prospective and concomitant assessment of HRQoL and OHRQoL after different treatment regims. Hence, present study was designed to investigate HRQoL and OHRQoL in patients treated for OSCC using various modalities. METHODS: 135 OSCC patients were grouped according to treatment rendered into Group A: surgery only; Group B: post-surgical radiotherapy (PRT); and Group C: post-surgical chemo-radiation (PCRT). The 12-item Short Form Health Survey (SF-12) and Oral Health Impact Profile-14 (OHIP-14) were intervened to assess HRQoL and OHRQoL respectively at 1-month and 6-months post-treatment. RESULTS: At 1-month post-treatment, patients who received PCRT showed significantly lower mean values for physical and mental domains of SF-12 and higher mean subscales and overall OHIP-14 (24.57 â€‹± â€‹2.62) score than those treated by surgery alone (10.55 â€‹± â€‹2.26) and PRT (20.20 â€‹± â€‹3.80), with largest differences between PCRT and surgery alone groups (p â€‹< â€‹0.001). Social functioning, general health and bodily pain of SF-12 and functional limitations, physical pain and physical disability amongst OHIP-14 domains were greatly affected. Although few physical domains of SF-12 showed significant improvement, mental domains remained a greater problem after 6 months. However, OHRQoL was significantly poor in all the three study groups (p â€‹< â€‹0.001). CONCLUSION: Irrespective of the post-treatment duration, patients who received PCRT had worse HRQoL and OHRQoL. There is a need to identify factors associated with impaired HRQoL and OHRQoL to customize better therapeutic decisions.

Oral Psychosomatic Disorders in Family Caregivers of Oral Squamous Cell Carcinoma Patients.

OBJECTIVE: To investigate the oral psychosomatic disorders (PSDs) in family caregivers (FCs) of oral cancer (OC) patients and to evaluate the correlation between these oral PSDs to severity of depression anxiety and stress. METHODS: A total of 50 participants were included each in first degree relative (FDR), second degree relative (SDR) and control group. All the participants completed DASS-21 questionnaire and were subjected to thorough clinical history and oral examination. RESULTS: All the FCs reported statistically significant higher mean levels of depression, anxiety and stress compared to controls (p˂0.001). A significantly greater number of FCs (40.00%) reported oral PSDs than control group (12.00%). Most prevalent oral PSD in FCs was aphthous stomatitis followed by oral lichen planus, bruxism, burning mouth syndrome and myofascial pain dysfunction syndrome. Moreover, there was a preponderance of these diseases in FDR (60.86%) compared to SDR (26.08%). FCs with moderate to very severe depression, anxiety and stress showed higher prevalence of these oral PSDs compared to the ones with mild depression, anxiety and stress. CONCLUSION: The observations of higher prevalence of oral PSDs in FCs with psychological alterations can enhance healthcare professionals' awareness to better understand FCs' oral healthcare needs.
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Low Lymphatic Vessel Density Correlates with Lymph Node Metastasis in Oral Squamous Cell Carcinoma.

STATEMENT OF THE PROBLEM: Regional lymph nodes are the nodes draining lymph from region around the tumor and presence of metastatic tumor in regional lymph nodes is the most important prognostic factor for malignant tumors of epithelial origin. Lymphangiogenesis is associated with an increased incidence of regional lymph nodes metastasis and is possibly an essential step for metastasis. Tumor cells secrete lymphangiogenic cytokines, which results in formation of lymphatic vessels within and around the tumor and act as portals for tumor spread. PURPOSE: The present study aims to investigate and quantify lymphatic vessel density (LVD) in oral squamous cell carcinoma (OSCC) and determine whether LVD can predict the risk of sentinel lymph node metastasis. MATERIAL AND METHOD: 50 specimens of OSCC, without and with lymph node metastasis (25 each) along with 25 specimens of normal oral mucosa were assessed and LVD was quantified by D2-40 immunostaining. Discrete hotspots of intratumoral lymphatics were identified in superficial and deep areas in all carcinomas to calculate LVD. RESULTS: When compared to normal mucosa, LVD decreased in the superficial intratumoral areas and decreased further in deep areas. In addition, LVD in the superficial and deep areas of OSCC without nodal metastasis was significantly higher than that in OSCC with nodal metastasis. CONCLUSION: Our study provides evidence that lymphangiogenesis varies within the tumor. Lymphatic vessels are either compressed, collapsed, destroyed or absent in deep intratumoral region. Decrease in LVD predicts cervical lymph node metastasis both in superficial and deep areas. Lymphatics in superficial areas are probably major conduit for nodal metastasis in OSCCs.