Mucormycosis in head and neck area - the emerging health problem in COVID-19 pandemic. The perspective of a dental practitioner.

Mucormycosis is an invasive fungal disease caused by saprophytic molds and is characterized by a fulminant course and high mortality. Reported increase of disease cases and more frequent mucormycosis superinfections in COVID-19 patients are of a serious concern. Head and neck area is the most typical location of mucormycosis and often the first symptoms are eminent in oral cavity, therefore a dentist may be the first healthcare practitioner to recognize signs of this dangerous and potentially fatal disease. Urgent diagnosis and implementation of appropriate treatment are essential for the patient's survival. The dentist's participation in postoperative care is necessary and due to the destructive nature of radical surgical treatment, prosthetic rehabilitation is required to improve the patient's function and quality of life. Furthermore the vigilance of dentists will also allow early recognition of frequent recurrences of this insidious infection.

Evidence of orofacial myofunctional therapy patients with asthma and rhinitis: a systematic review.

PURPOSE: to evaluate the efficacy of orofacial myofunctional therapy in improving orofacial function and nasal breathing in patients with asthma and rhinitis and, consequently, achieve clinical control of these conditions. RESEARCH STRATEGIES: We used the elements of the PICOT method (study population, intervention, comparison, outcomes and type of studies) to define the eligibility criteria: (1) Population: patients with asthma and rhinitis; (2) Intervention: orofacial myofunctional therapy to improve chewing, swallowing, and breathing; (3) Comparison: control group without orofacial myofunctional therapy; (4) Predefined outcomes: clinical control of asthma and improvement of orofacial functions and nasal breathing; (5) Study type: clinical trials. The data were collected from PubMed, SCOPUS, Web of Science, Science Direct, LILACS, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), OATD, and Open Thesis, in November 2018. SELECTION CRITERIA: Randomized controlled trials published in full-text versions without language restriction, no filter was used. DATA ANALYSIS: Demographic characteristics of study participants, specific diagnosis of asthma and control medication, type, duration, intensity and follow-up of orofacial myofunctional therapy, and outcome data. The risk of bias was assessed according to the Cochrane guidelines for clinical trials. RESULTS: One study met the eligibility criteria: although the study has shown an improvement of functional control and clinical scores of asthma, the evidence is very low. CONCLUSION: There is no scientific evidence on the efficacy of orofacial myofunctional therapy in improving clinical control, orofacial function, and nasal breathing in patients with asthma and rhinitis.

Evidence of orofacial myofunctional therapy patients with asthma and rhinitis: a systematic review / Evidência da terapia miofuncional orofacial em pacientes com asma e rinite: Uma revisão sistemática

ABSTRACT Purpose to evaluate the efficacy of orofacial myofunctional therapy in improving orofacial function and nasal breathing in patients with asthma and rhinitis and, consequently, achieve clinical control of these conditions. Research strategies We used the elements of the PICOT method (study population, intervention, comparison, outcomes and type of studies) to define the eligibility criteria: (1) Population: patients with asthma and rhinitis; (2) Intervention: orofacial myofunctional therapy to improve chewing, swallowing, and breathing; (3) Comparison: control group without orofacial myofunctional therapy; (4) Predefined outcomes: clinical control of asthma and improvement of orofacial functions and nasal breathing; (5) Study type: clinical trials. The data were collected from PubMed, SCOPUS, Web of Science, Science Direct, LILACS, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), OATD, and Open Thesis, in November 2018. Selection criteria Randomized controlled trials published in full-text versions without language restriction, no filter was used. Data analysis Demographic characteristics of study participants, specific diagnosis of asthma and control medication, type, duration, intensity and follow-up of orofacial myofunctional therapy, and outcome data. The risk of bias was assessed according to the Cochrane guidelines for clinical trials. Results One study met the eligibility criteria: although the study has shown an improvement of functional control and clinical scores of asthma, the evidence is very low. Conclusion There is no scientific evidence on the efficacy of orofacial myofunctional therapy in improving clinical control, orofacial function, and nasal breathing in patients with asthma and rhinitis.

RESUMO Objetivo avaliar a eficácia da terapia miofuncional orofacial na melhora das funções orofaciais, na respiração nasal em pacientes com asma e rinite e, consequentemente, alcançar o controle clínico das doenças. Estratégia de pesquisa Utilizamos a estratégia PICOT (população, intervenção, comparação, resultado e tipo de estudo) para definir os critérios de elegibilidade: (1) População: pacientes com asma e rinite; (2) Intervenção: terapia miofuncional orofacial, para melhora da mastigação, deglutição e respiração; (3) Comparação: grupo controle sem terapia miofuncional orofacial; (4) Desfechos pré-definidos: controle clínico da asma e melhora das funções orofaciais e respiração nasal; (5) Tipo de estudo: ensaios clínicos. Os dados foram coletados no PubMed, SCOPUS, Web of Science, Science Direct, LILACS, Google Scholar, Cochrane Central Register de Ensaios Controlados (CENTRAL), OATD, Open thesis, Novembro de 2018. Critérios de seleção Ensaios controlados randomizados publicados em versões de texto completo, sem restrição de idioma, nenhum filtro foi utilizado. Análise dos dados Foram avaliadas as características demográficas dos participantes do estudo, diagnóstico específico de asma e medicação de controle, tipo, duração, intensidade, acompanhamento da terapia miofuncional orofacial e dados do desfecho. O risco de viés foi avaliado de acordo com as diretrizes da Cochrane para ensaios clínicos. Resultados Um estudo atendeu aos critérios de elegibilidade. Embora o estudo tenha mostrado melhora do controle funcional e escores clínicos da asma, as evidências são baixas. Conclusão Não há evidências científicas sobre a eficácia da terapia miofuncional orofacial na melhora do controle clínico, funções orofaciais e respiração nasal em pacientes com asma e rinite.

[The role of non-medicamental technologies in the rehabilitation of the children presenting with acute rhinosinusitis].

Despite the recent achievements in diagnostics and pharmacotherapy of acute rhinosinusitis in the children, the problem of management of this pathology, thus far remains a serious challenge for practical medicine. The objective of the present study was to develop a scientifically sound rationale for the application of halotherapy (HT) and magnetic therapy (MT) or their combination for the treatment of acute rhinosinusitis in the children. The clinical observations and special investigations were carried out in the comparative aspect and encompassed 120 children at the age varying from 5 to 15 years suffering from acute rhinosinusitis. The therapeutic effectiveness of the rehabilitative treatment was evaluated based on the results of the endoscopic study of the nasal cavity, analysis of the X-ray images of paranasal sinuses, rhinomanometry, investigations into the ciliary activity, and assessment of the mucosal immunity. The results of the present study gave evidence of the feasibility of incorporating HT and MT in the combined treatment of the children presenting with acute rhinosinusitis. The integrated use of the two methods proved to have the advantage over the separate application of either of them. The specific effects of HT and MT on the clinical course of acute sinusitis and the functional state of intranasal mucosa are described. The optimal methods of the treatment are proposed.

Functional recovery of rabbit maxillary sinus mucosa in two different experimental injury models.

OBJECTIVE/HYPOTHESIS: Ciliary wave disorder (CWD) is essential for effective mucociliary transport. The purpose of this study was to investigate morphologic and functional restoration in recovered sinus mucosa after 12 weeks of experimentally induced rhinosinusitis and regenerated sinus mucosa after mechanical injury. STUDY DESIGN: Prospective study with animal models. METHODS: Ten New Zealand white rabbits weighing between 2.5 and 3 kg were used for this experiment. In the recovered mucosa group (n = 5), the natural ostium of the maxillary sinus was closed with a synthetic sponge and removed 2 weeks later. In the regenerated sinus mucosa group (n = 5), maxillary sinus mucosa was stripped off through the anterior wall. Left sinus mucosae were used as controls. Twelve weeks postoperatively, ciliary beat frequency (CBF) and CWD were measured using an image analysis system. Morphologic changes in cilia were also observed using a scanning electron microscope (SEM). RESULTS: The average CBFs in control, recovered, and regenerated mucosa were 13.21 +/- 3.66 Hz, 13.20 +/- 3.53 Hz, and 14.16 +/- 3.87 Hz, respectively. The average CWDs in these groups were 8.46 +/- 4.4, 21.04 +/- 14.73, and 24.43 +/- 19.2, respectively. SEM showed that loss of cilia and irregularities of ciliary arrangements were prominent in regenerated sinus mucosa. CONCLUSION: Although 12 weeks is enough for morphologic regeneration of the ciliated epithelium after experimental sinusitis in rabbit maxillary sinuses, it does not appear long enough for full functional recovery. Restoration of CBFs does not equate to concurrent CWD restoration.

Allergic rhinitis and asthma ad hoc survey: clinical and psychological perspectives.

BACKGROUND: Several studies have provided evidence of a strong association between asthma and rhinitis, with consequences in terms of therapy and disease management. OBJECTIVES: The aims of our study were to evaluate physicians' knowledge about rhinitis/asthma comorbidity, to note the patients' management behaviour and to assess the patients' experience about symptoms and expectations, and to investigate the clinical and psychological meaning of general practitioners' and patients' awareness. METHODS: One hundred and one general practitioners and 504 asthmatic patients participated in the study. General practitioners and patients filled in two different multiple choice questionnaires concerning asthma-rhinitis link and impact. RESULTS: 34.7% of general practitioners are aware of the link between asthma and rhinitis, and 43.6% of them hypothesize the comorbidity on the basis of their clinical experience. 21.8% of physicians make the diagnosis autonomously. 27.8% of asthmatic patients experience three or less rhinitic symptoms, 41% from four to six symptoms and 31.2 more than six symptoms. These symptoms deeply interfere with daily life, causing sleep problems (87.3%), lack of concentration (78.9%), difficulties in spare time (71.8%) and sport (71.7%). Rhinitis symptoms are responsible for the worsening of asthma, with an increase in dyspnoea (86.3%), cough (73.9%), and wheezing (59%). Ninety-three percent of patients expressed an interest in a combination therapy approach. CONCLUSIONS: Asthma and rhinitis interact in the development of clinical burden and impact on quality of life. The survey results showed different perspectives when evaluated from clinical and psychological points of view.

Gender and age differences in the relative burden of rhinitis and asthma on health-related quality of life--a Swedish population study.

The aim of this study was to investigate the relative burden of rhinitis and asthma on health-related quality of life (HRQL) as a function of gender and age in the general population. A cross-sectional, general population survey was conducted, comprising 5918 men and women aged 16-64 years. The SF-36 Health Survey was administered by mail, along with questions regarding nasal complaints after 15 years of age and physician-diagnosed asthma. Overall, rhinitis and asthma were each associated with impaired HRQL compared with non-cases and the burden of these illnesses in combination was incremental. In the age group 16-49 years, men and women with rhinitis alone had significantly worse health profiles on most scales than non-cases, while asthmatics, with or without rhinitis, showed further decrements on only a few scales. In the age group 50-64 years, men with rhinitis did not differ from non-cases and no differences were found between asthmatics and rhinitis victims on any scale. In contrast, women aged 50-64 years with rhinitis had significantly worse scores than non-cases on bodily pain and general well-being scales (GH, VT), and asthmatics scored much lower on all scales than those with rhinitis alone. The negative association of rhinitis and asthma with HRQL differs by age and sex in the general population. Women aged 50-64 years with one or both ailments are particularly affected. Such gender and age differences should be taken into consideration in the care and treatment of patients with rhinitis and asthma.

Manejo médico quirúrgico de la rinosinusitis / Surgical medical management of rhinosinusitis

El autor empieza mostrando estadísticas de presentación de esta enfermedad en Norteamérica y los gastos que ocasiones el tratamiento de dicha enfermedad. Así mismo plantea la clasificación en cuatro diferentes formas de presentación. Explica también los factores que podrían actuar, condicionantes para la presentación de las rinosinusitis crónicas. Finalizando con el manejo tanto médico como quirúrgico para este tipo de enfermedades.

The author shows some statistical information regarding the onset of this disease in North America and then he estimates the cost to treat the illness.The author classifies the Rhinosinusitis in four categories, he explains the factors that intervene in the presentation of the chronic rhinosinusitis. Finally, he describes the surgical approach to treat this sickness.