Exploring the Effect of Combined Transcranial and Intra-Oral Photobiomodulation Therapy Over a Four-Week Period on Physical and Cognitive Outcome Measures for People with Parkinson's Disease: A Randomized Double-Blind Placebo-Controlled Pilot Study.

BACKGROUND: Neuroprotection against Parkinson's disease degeneration by photobiomodulation has been reported in animal models but no true placebo-controlled human studies have been published. OBJECTIVE: To understand if photobiomodulation therapy can produce clinically significant differences in physical performance measures in people with Parkinson's disease; and what frequency of treatment is necessary to initiate clinical change. METHODS: In a participant and assessor-blinded, randomized, placebo-controlled pilot study, 22 participants received either sham and/or active laser photobiomodulation (904 nm, 60 mW/diode, 50 Hz) for 33 s to each of 21 points at the cranium and intra-orally, on one, two or three times/week for 4 weeks. Two treatment phases were separated by a 4-week wash-out (Phase 2). Upper and lower limb physical outcome measures were assessed before and after each treatment phase. The Montreal Cognitive Assessment was evaluated prior to treatment Phase 1, and at the end of treatment Phase 3. RESULTS: Montreal Cognitive Assessment remained stable between start and end of study. No measures demonstrated statistically significant changes. With regular treatment, the spiral (writing) test and the dynamic step test were most sensitive to change in a positive direction; and the 9-hole peg test demonstrated a minimum clinically important difference worthy of further investigation in a larger, adequately powered clinical trial. A placebo effect was noted. CONCLUSION: The results support the notion that combined transcranial and intra-oral photobiomodulation therapy needs to be applied at least 2 to 3 times per week for at least four weeks before some improvement in outcome measures becomes evident. Longer courses of treatment may be required.

Review of the Current Medical and Surgical Treatment Options for Microstomia in Patients With Scleroderma.

BACKGROUND: Most patients with scleroderma suffer from microstomia, which can have debilitating consequences on their quality of life. Unfortunately, treatment options remain limited. No specific guidelines exist; hence, microstomia remains a challenge to treat in this patient population. OBJECTIVE: This review aims to evaluate the different medical and surgical treatment modalities currently available for microstomia in patients with scleroderma and make recommendations for future research. MATERIALS AND METHODS: A search of PubMed, Ovid MEDLINE, and Ovid Embase was conducted to identify articles discussing the treatment of microstomia in scleroderma. Twenty articles discussing surgical therapy and one article discussing medical therapy were reviewed. RESULTS: Mostly because of a scarcity of high-level evidence, no individual therapy has documented long-term efficacy. Some treatments demonstrate positive results and warrant further research. CONCLUSION: Given the variability of results, specific recommendations for the treatment of microstomia in patients with scleroderma are difficult to establish. A multifaceted approach that includes surgical and medical therapy is likely the best option to improve oral aperture in this patient population. Surgical treatments such as neurotoxins, autologous fat grafting, and ultraviolet A1 phototherapy may hold the most potential for improvement.

Dosimetric measurement of scattered radiation for simulated head and neck radiotherapy with homemade oral phantom.

During radiotherapy for head and neck tumours, the oral cavity and cheek area would be inevitably exposed to high energy radiation; thus, the material surface of the teeth, dental restorations with high atomic number, or alloy prosthodontics would generate backscatter electrons that cause the buccal mucosa adjacent to these materials to receive localized high dose enhancement, which primarily leads to side effects or oral mucositis. Based on the size of the adult oral cavity, this study aimed to use acrylic resin to create an oral phantom with two grooves on the left and right sides for placement of three molars. Moreover, the distance between the inner cheek and the side surface of the teeth could be accurately adjusted every 1 mm from 0 to 5 mm. This enhanced the dose in the buccal mucosa during head and neck radiotherapy and made the distribution measurement of the radiation dose simple and feasible at different depths (0-5 mm). Meanwhile, the study employed the film type optically stimulated luminescent dosimeter with a thickness of 0.3 mm to measure the absorbed dose inside the buccal mucosa to reduce the dose interference from radiotherapy. The study fixed three real molars in a row located at the left side of the phantom and employed 6 MV photons and intensity-modulated radiotherapy (IMRT) to treat and simulate oral cancer and measure the attenuation of the molar's backscatter dose from 0 to 5 mm in an up beam direction. The result showed that, in every 3 mm, the phantom had attenuated the enhancement of backscatter dose <3%. The irradiation dose enhancement in a single direction was twice higher than that through IMRT 7 field treatment. These measurement results were consistent with the results of previous studies.

Photobiomodulation by low-level laser therapy in patients with obstructive sleep apnea: Study protocol clinical trial (SPIRIT compliant).

Obstructive sleep apnea (OSA) increases morbidity and mortality and it is associated with an increased cardiovascular risk. The gold standard treatment for OSA is positive airway pressure therapy (CPAP). However, it is an expensive treatment and several patients do not adapt to CPAP. GOAL: The researchers will verify the effects of low-level laser therapy (LLLT) on OSA, when applied to the soft palate and on the tongue base. METHODS: The researchers will select individuals of both sexes aged 30 to 60 years old who are sedentary and that present a high risk of OSA by the Berlin questionnaire. The evaluations pre and post interventions will be polysomnography; anthropometric and body composition measurements (Bioimpedance); metabolic syndrome risk factors (International Diabetes Federation); physical capacity (VO2 peak at the cardiopulmonary exercise test, CPET); endothelial function (flow-mediated dilatation, FMD); autonomic control (heart rate variability and sympathovagal balance). Those diagnosed with moderate and severe OSA (apnea/hypopnea index, AHI ≥15 events/h) will be invited to participate in the study and they will be randomized into 2 groups: LLLT treatment or placebo (C). The LLLT group will receive applications at 8 points on the soft palate and on the base of the tongue for 8 seconds for each point. The applications of LLLT will occur twice a week, with a minimum interval of 2 days between the applications for 2 months, when using a Therapy Plus NS 13678 Laser. The C group will have similar applications, but with the device turned off. EXPECTED RESULTS: In the individuals with OSA, photobiomodulation through LLLT will decrease the AHI. Additionally, when LLLT is applied in the oral cavity, a highly vascularized region, this may cause improvements in the vascular function and in the autonomic and hemodynamic control. ETHICS AND DISSEMINATION: This protocol was approved by the Research Ethics Committee of the Nove de Julho University, São Paulo, Brazil, on the date of March 11, 2019 (CAAE: 06025618.2.0000.5511 - Acceptance Number: 3.191.077). This trial has been registered with the Brazilian Registry of Clinical Trials (REBEC TRIAL RBR-42v548). This study is not yet recruiting. Issue date: November 4, 2019.

Influence of remoteness of residence on timeliness of diagnosis and treatment of oral cavity and oropharynx cancer: A retrospective cohort study.

INTRODUCTION: Geographic disparities in head and neck cancer (HNC) outcomes in Australia may be mediated by timeliness of diagnosis and treatment. This retrospective cohort study examines geographic variations in survival and time intervals leading up to treatment for HNC at two tertiary referral centres in New South Wales. METHODS: Eligible patients were NSW residents aged ≥18 years, diagnosed with primary oropharynx or oral cavity squamous cell carcinoma (SCC) between 01 July 2008 and 30 June 2013, and treated with curative intent. Main outcomes were times from diagnosis to treatment and from surgery to post-operative radiotherapy and overall survival. Differences based on remoteness of residence (regional/remote or metropolitan) were assessed. RESULTS: A total of 224 patients were eligible. Median time from symptom onset to treatment was longer for regional/remote patients with oropharynx SCC (4.7 vs. 3.8 months, P = 0.044) and oral cavity SCC (6.4 vs. 3.3 months, P = 0.003). Median time from diagnosis to treatment was longer for regional/remote patients with oropharyngeal SCC (47 days vs. 36 days, P = 0.003). Time from surgery to adjuvant radiotherapy was longer among regional/remote patients with oral cavity SCC (66 vs. 42 days, P = 0.001). Overall survival did not differ based on remoteness. CONCLUSION: Regional/remote HNC patients experienced longer times to diagnosis and treatment, and regardless of remoteness of residence, fewer than half of patients were treated within guideline recommended timeframes. Despite this non-adherence to guidelines, there were no differences in survival outcomes among this cohort. However, the impact of not meeting guidelines on patient outcomes other than survival warrants further investigation.

Characterization of a partial-body irradiation model with oral cavity shielding in nonhuman primates.

Purpose: Characterization of a novel partial-body irradiation (PBI) shielding strategy in nonhuman primates (NHP; rhesus macaques), aimed at protecting the oral cavity, with respect to various gastrointestinal acute radiation syndrome (GI-ARS) syndrome parameters as well as buccal ulceration development.Materials and methods: NHPs were irradiated using a Cobalt-60 gamma source, in a single uniform dose, ranging from 9-13 Gy and delivered at 0.60-0.80 Gy min-1. Animals were either partially shielded via oral cavity shielding (PBIOS) or underwent total-body irradiation (TBI).Results: Clinical manifestations of GI-ARS, and also radiation-induced hematology and clinical chemistry changes, following PBIOS were comparable to the PBI NHP GI-ARS model utilizing shielding of the distal pelvic limbs and were significantly milder than TBI at similar radiation doses. Nadir citrulline levels were comparable between PBIOS and TBI but signs of recovery appeared earlier in PBIOS-treated animals. The PBIOS model prevented oral mucositis, whereas the TBI model presented buccal ulcerations at all tested radiation dose levels.Conclusions: Taken together, these results suggest that the PBIOS model is a suitable alternative to traditional PBI. For GI-ARS investigations requiring orally administered medical countermeasures, PBIOS confers added value due to the prevention of oral mucositis over traditional PBI.

Micro-endoscopic In Vivo Monitoring in the Blood and Lymphatic Vessels of the Oral Cavity after Radiation Therapy.

Radiotherapy, although used worldwide for the treatment of head, neck, and oral cancers, causes acute complications, including effects on vasculature and immune response due to cellular stress. Thus, the ability to diagnose side-effects and monitor vascular response in real-time during radiotherapy would be highly beneficial for clinical and research applications. In this study, recently-developed fluorescence micro-endoscopic technology provides non-invasive, high-resolution, real-time imaging at the cellular level. Moreover, with the application of high-resolution imaging technologies and micro-endoscopy, which enable improved monitoring of adverse effects in GFP-expressing mouse models, changes in the oral vasculature and lymphatic vessels are quantified in real time for 10 days following a mild localized single fractionation, 10 Gy radiotherapy treatments. Fluorescence micro-endoscopy enables quantification of the cardiovascular recovery and immune response, which shows short-term reduction in mean blood flow velocity, in lymph flow, and in transient immune infiltration even after this mild radiation dose, in addition to long-term reduction in blood vessel capacity. The data provided may serve as a reference for the expected cellular-level physiological, cardiovascular, and immune changes in animal disease models after radiotherapy.

Therapeutic effect of laser on pediatric oral soft tissue problems: a systematic literature review.

In recent years, extensive evidence has been published about usage of laser in oral lesions. The aim of the present study was to review the effectiveness of laser radiation in the treatment of pediatric oral soft tissue problems. The relevant keywords were searched in EBSCO, Medline (via Ovid), PubMed, Scopus, and Web of Science (WOS) databases. Then, eligible case series and controlled clinical trial studies, which published up to the end of 2018, were extracted and scrutinized. In this study, the age range of ≤ 21 years or the average age of ≤ 21 years was considered as the pediatric group. After limiting the search results, removing duplicate titles and eligibility evaluation, 17 papers were enrolled to the study (seven controlled clinical trials and ten case series). Er:YAG (2940 nm), CO2 (10,600 nm), Er,Cr:YSGG (2780 nm), and diode (650, 660, and 975 nm) lasers indicated successful clinical results on mucocele excision, frenectomy, gingival incision and re-contouring, and treatment of vascular malformations. In addition, 660-nm diode laser radiation was an effective adjuvant treatment for halitosis and gingivitis induced by multi-bracket appliances. Reduction or absence of pain and bleeding, suitable homeostasis, reduction of operation time, less analgesic consumption, and antibacterial effect were among the advantages of the laser radiation in the studies. Laser as a main or adjuvant tool can have an effective role in surgical and non-surgical treatments of pediatric oral soft tissue problems. Conducting further randomized controlled trial studies on different soft tissue lesions can contribute to drawing better conclusions.

Early oral cavity cancer: The prognostic factors and impact of adjuvant radiation on survival.

BACKGROUND: Early oral cavity cancer has good prognosis but recurrence in them is still not uncommon. There is no general consensus on the prognostic factors and adjuvant therapy that would have a significant impact on survival. METHODS: A retrospective analysis of early oral cavity cancer patients during the time period 2009-2017. The data regarding demographics, histopathological features, and recurrence patterns were collected and analyzed. RESULTS: Depth of invasion (DOI) was the most important prognostic factor among all the factors analyzed. Further analysis showed that addition of adjuvant radiotherapy for patients with DOI >5 mm did not show survival benefits (P = .73). Another subset analysis of patients with DOI >10 mm also did not show any survival advantage with adjuvant therapy P = .24. CONCLUSION: There is no benefit of adding adjuvant RT in patients with DOI > 5 mm or in patients who were upstaged to T3 based only on DOI.

The prognostic value of CT-based image-biomarkers for head and neck cancer patients treated with definitive (chemo-)radiation.

OBJECTIVES: The aim of this study was to investigate whether quantitative CT image-biomarkers (IBMs) can improve the prediction models with only classical prognostic factors for local-control (LC), regional-control (RC), distant metastasis-free survival (DMFS) and disease-free survival (DFS) for head and neck cancer (HNC) patients. MATERIALS AND METHODS: The cohort included 240 and 204 HNC patients in the training and validation analysis, respectively. Clinical variables were scored prospectively and IBMs of the primary tumor and lymph nodes were extracted from planning CT-images. Clinical, IBM and combined models were created from multivariable Cox proportional-hazard analyses based on clinical features, IBMs, and both for LC, RC, DMFS and DFS. RESULTS: Clinical variables identified in the multivariable analysis included tumor-site, WHO performance-score, tumor-stage and age. Bounding-box-volume describing the tumor volume and irregular shape, IBM correlation representing radiological heterogeneity, and LN_major-axis-length showing the distance between lymph nodes were included in the IBM models. The performance of IBM LC, RC, DMFS and DFS models (c-index(validated):0.62, 0.80, 0.68 and 0.65) were comparable to that of the clinical models (0.62, 0.76, 0.70 and 0.66). The combined DFS model (0.70) including clinical features and IBMs performed significantly better than the clinical model. Patients stratified with the combined models revealed larger differences between risk groups in the validation cohort than with clinical models for LC, RC and DFS. For DMFS, the differences were similar to the clinical model. CONCLUSION: For prediction of HNC treatment outcomes, image-biomarkers performed as good as or slightly better than clinical variables.

Oral Candida colonization in xerostomic postradiotherapy head and neck cancer patients.

OBJECTIVES: To evaluate (a) oral colonization of Candida species, especially for non-albicans Candida species (NACS), in xerostomic postradiotherapy head and neck cancer patients and (b) risk factors affecting their colonization. MATERIALS AND METHODS: Subjective and objective dry mouth scores, stimulated salivary flow rates, pH and buffering capacity were measured in 72 xerostomic postradiotherapy head and neck cancer patients. Candida counts and species identification were performed using oral rinse samples cultured in Candida Chromagar, followed by polymerase chain reaction and API 20C AUX system. RESULTS: Candida colonization was observed in 87.5% of subjects, with 80.6% and 48.6% of study population colonized by C. albicans and NACS, respectively. NACS was associated with high objective dry mouth scores, denture use, and females (p = .006, .009, and .036, respectively). In addition, Candida glabrata was detected more in females (p = .018) and denture wearers (p = .026), while Candida tropicalis was associated with high objective dry mouth scores (p = .022) and females (p = .027). Quantity of Candida colonization correlated positively with objective dry mouth scores (r = 0.599, p < .001) and negatively with salivary flow rates (r = -0.258, p = .041) and pH (r = -0.290, p = .022). CONCLUSION: NACS colonization was common in xerostomic head and neck cancer patients. Increased signs of dry mouth, female and dental prostheses may promote NACS colonization.

Relationship between patient and physician-rated xerostomia and dose distribution to the oral cavity and salivary glands for head and neck cancer patients after radiotherapy.

Introduction: Xerostomia is a frequent complication after curative intended radiotherapy (RT) for head and neck squamous cell carcinoma (HNSCC). Assessment of xerostomia is commonly done by the physician. The aim of this study is to investigate the relation between patient and physician-rated xerostomia and to predict the degree of xerostomia from patients with self-reported xerostomia based on delivered doses to the oral cavity, parotid, and submandibular glands. Material and methods: During a 2-year period, consecutive HNSCC patients attending the follow-up clinic were included. All included patients had self-reported xerostomia, and completed the disease-specific EORTC QLQ-H&N35 questionnaire. The physician assessed the degree of xerostomia with the DAHANCA toxicity scale and was blinded for the EORTC score. Oral cavity, parotid, and submandibular glands (OAR) were delineated on the planning CT according to international guidelines. DVH were extracted from treatment plans. Logistic regression tested the relation between mean doses, patient characteristics, and xerostomia scores. Differences between DVH values and scoring of xerostomia were analyzed with a Kruskal-Wallis test. The relation between xerostomia and dose distributions was further investigated using principal component analysis (PCA). Results: In total, 109 patients were included in the study. A weak correlation was seen between patient and physician-rated toxicity (p = .001), however, in general patients reported more toxicity than physicians. For EORTC score ≥2, the multi-variable analysis was significant for doses to the oral cavity, tobacco status and use of xerogenic medication. Neither the DVH analysis nor the PCA found any clear distinction between xerostomia scores for EORTC or DAHANCA and investigated OARs. Conclusion: Patients tended to report higher scores of xerostomia than the physician. PCA indicated a complex relation between doses to the OAR and xerostomia scores, showing e.g., that reducing doses in one organ was on the expense of increased dose to another organ.

Speech-language therapy program for mouth opening in patients with oral and oropharyngeal cancer undergoing adjuvant radiotherapy: a pilot study. / Programa terapêutico fonoaudiológico para abertura de boca em pacientes com câncer de boca e orofaringe em radioterapia adjuvante: estudo piloto.

Purpose Assess the effectiveness of an orofacial myofunctional therapeutic program in patients with oral or oropharyngeal cancer submitted to adjuvant radiotherapy through pre- and post-program comparison of maximum mandibular opening. Methods Prospective study involving five adult patients and five elderly patients postoperatively to oral cavity/oropharynx surgery who were awaiting the beginning of radiotherapy or had undergone fewer than five treatment sessions. The study participants had their maximum jaw opening measured using a sliding caliper at the beginning and end of the program. Two mobility exercises and three mandibular traction exercises were selected and weekly monitored presentially for 10 weeks. Descriptive data and pre- and post-therapy comparative measures were statistically analyzed using the Wilcoxon test. Results Ten patients (two women and eight men) with mean age of 58.4 years, median of 57.0 years, completed the therapeutic program. They presented mean maximum mandibular opening of 31.6 ± 11.7 and 36.4 ± 8.0 mm pre- and post-therapy, respectively (p =0.021). Conclusion The proposed orofacial myofunctional therapeutic program increased the maximum jaw opening of patients referred to adjuvant radiotherapy for oral cavity or oropharynx cancer treatment.

Effect of GaAlAs low-level laser therapy on mouth opening after orthognathic surgery.

To evaluate low-level laser therapy (LLLT) as an adjunct to enhance postoperative mouth opening after orthognathic surgery. Prospective clinical trial of 82 patients allocated into an intervention group (laser, LG) and a control group (no laser, CG) and subgroups according to the procedure type : (1) surgically assisted rapid maxillary expansion (SARME); (2) maxillary surgery; (3) mandibular surgery; or (4) bimaxillary surgery. LG patients received LLLT immediately after surgery and every 24 h thereafter for 3 days, using a gallium-aluminum-arsenide (GaAlAs) diode laser (780 nm, 28 spots, 14 on each side of the face, output power 2 J/spot). Maximum mouth opening was measured using digital calipers at five time points: preoperative baseline and postoperative days 2, 7, 14, and 21. ANOVA was used to evaluate difference in mouth opening across groups. Significance was accepted at P ≤ 0.05. Final average mouth opening differed between women (GL1 = 94.24%, GC1 = 89.54%, GL2 = 69.39%; GC2 = 68.46%; GL3 = 65.11%; GC3 = 58.64%; GL4 = 61.85%; GC4 = 57.11%) and men (GL1 = 86.92%, GC1 = 102.44%, GL2 = 77.56%; GC2 = 81.65%; GL3 = 80.29%; GC3 = 67.63%; GL4 = 66.93%; GC4 = 55.31%). There were no significant differences between the SARME and isolated maxillary/mandibular surgery groups. In the bimaxillary groups, average mouth opening was increased in all patients who received LLLT, significantly so in male patients. LLLT with a GaAlAs diode laser (780 nm) did not affect postoperative mouth opening after SARME, isolated maxillary surgery, or isolated mandibular surgery. However, it improved mouth opening in men who had undergone bimaxillary orthognathic surgery.

Sunlight-induced genotoxicity and damage in keratin structures decrease tadpole performance.

The increased incidence of solar ultraviolet (UV) radiation, an environmental genotoxic agent, due to ozone depletion or deforestation may help to explain the enigmatic decline of amphibian populations in specific localities. In this work, we evaluated the importance of DNA repair performed by photolyases to maintain the performance of treefrog tadpoles after acute and chronic treatments with environmental-simulated doses of solar UVB and UVA radiation. Immediately after UV treatments, tadpoles were exposed to a visible light source to activate photolyases or kept in dark containers. The biological effects of UV treatments were evaluated through morphological, histological, locomotor and survival analyzes of Boana pulchella tadpoles (Anura: Hylidae). The results indicate that tadpole body weight suffered influence after both UVB and UVA treatments, although the body length was bit affected. The locomotor performance of UVB-exposed tadpoles was significantly reduced. In addition, UVB radiation induced a severe impact on tadpole skin, as well as on keratinized structures of mouth (tooth rows and jaw), indicating that these should be important effects of solar UV radiation in the reduction of tadpole performance. Furthermore, photolyases activation was fundamental for the maintenance of tadpole performance after chronic UVB exposures, but it was relatively inefficient after acute exposures to UVB, but not to UVA radiation. Therefore, this work demonstrates how the UV-induced genotoxicity and structural alterations in the skin and oral apparatus affect tadpole performance and survival.

Programa terapêutico fonoaudiológico para abertura de boca em pacientes com câncer de boca e orofaringe em radioterapia adjuvante: estudo piloto / Speech-language therapy program for mouth opening in patients with oral and oropharyngeal cancer undergoing adjuvant radiotherapy: a pilot study

RESUMO Objetivo Analisar, por meio da comparação entre a abertura máxima mandibular, a efetividade de programa terapêutico miofuncional oral em pacientes com câncer de boca ou orofaringe submetidos à radioterapia adjuvante. Método Estudo prospectivo envolvendo cinco pacientes adultos e cinco idosos em pós-operatório de cirurgia de boca/orofaringe que aguardavam início da radioterapia ou até a quinta sessão. No início e no final do programa, os participantes tiveram suas medidas de abertura máxima mandibular mensuradas por meio de paquímetro e foram selecionados cinco exercícios - dois de mobilidade e três de tração mandibular - com controle presencial durante oito semanas, perfazendo um total de dez semanas. Dados descritivos e a comparação das medidas pré e pós-fonoterapia por meio do teste de Wilcoxon foram considerados na análise dos dados. Resultados Dez pacientes finalizaram o programa terapêutico (duas mulheres e oito homens), com média de idade de 58,4 anos, mediana de 57,0 anos. Apresentaram média de abertura máxima mandibular de 31,6 ± 11,7 mm antes do tratamento e 36,4 ± 8,0 mm no pós-terapia (p=0,021). Conclusão O programa terapêutico miofuncional oral proposto promoveu aumento da abertura máxima vertical da mandíbula de pacientes submetidos à radioterapia e/ou quimioterapia adjuvante para tratamento de câncer de boca e orofaringe.

ABSTRACT Purpose Assess the effectiveness of an orofacial myofunctional therapeutic program in patients with oral or oropharyngeal cancer submitted to adjuvant radiotherapy through pre- and post-program comparison of maximum mandibular opening. Methods Prospective study involving five adult patients and five elderly patients postoperatively to oral cavity/oropharynx surgery who were awaiting the beginning of radiotherapy or had undergone fewer than five treatment sessions. The study participants had their maximum jaw opening measured using a sliding caliper at the beginning and end of the program. Two mobility exercises and three mandibular traction exercises were selected and weekly monitored presentially for 10 weeks. Descriptive data and pre- and post-therapy comparative measures were statistically analyzed using the Wilcoxon test. Results Ten patients (two women and eight men) with mean age of 58.4 years, median of 57.0 years, completed the therapeutic program. They presented mean maximum mandibular opening of 31.6 ± 11.7 and 36.4 ± 8.0 mm pre- and post-therapy, respectively (p =0.021). Conclusion The proposed orofacial myofunctional therapeutic program increased the maximum jaw opening of patients referred to adjuvant radiotherapy for oral cavity or oropharynx cancer treatment.

Impact of induction chemotherapy to concurrent chemoirradiation over radiotherapy alone in advanced oral cavity.

BACKGROUND: Oral and oropharyngeal carcinomas representing about 90% of all oral malignancies are the sixth most common cancers worldwide. Basic modalities of cancer treatment are surgery, radiotherapy, and chemotherapy (CT) either alone or in combination. For squamous cell carcinoma (SCC) patients, induction CT followed by radiotherapy and concurrent CT are effective methods for improving response rates. MATERIALS AND METHODS: Fifty patients with advance stage oral cavity cancer with performance status >60% on Karnofsky performance scale and having no prior exposure to CT, radiotherapy, and surgery were included in the study. CT including bleomycin, methotrexate, and cisplatin was given on day 1 and repeated at an interval of 21 days. After the completion of three cycles, two groups (n = 25 each) were formed. One group was treated with radiotherapy alone and other group of patients treated with radiotherapy and concurrent cisplatin infusion. The patient toxicities and response were evaluated. RESULTS: After completion of induction CT, both the groups responded with almost similar result. Nausea, vomiting, mucositis, and skin reactions during radiotherapy were observed in both groups but comparatively higher in Group "B." In Group B, 84% (vs. 60% in Group A) of patients showed complete response (CR) after completion of treatment, and out of 13 patients who responded partially to induction CT, 9 patients showed CR after concurrent chemoradiotherapy. CONCLUSION: This study showed the superiority of induction followed by concurrent chemoradiotherapy over induction plus radiotherapy alone in the treatment of advanced oral cavity neck SCC.

Oral complications at 6 months after radiation therapy for head and neck cancer.

OBJECTIVE: To examine oral complications 6 months after modern radiation therapy (RT) for head and neck cancer (HNC). METHODS: Prospective multicenter cohort study of patients with HNC receiving intensity-modulated radiation therapy or more advanced RT. Stimulated whole salivary flow, maximal mouth opening, oral mucositis, oral pain, oral health-related quality of life (OH-QOL), and oral hygiene practices were measured in 372 subjects pre-RT and 216 subjects at 6 months from the start of RT. RESULTS: Mean stimulated whole salivary flow declined from 1.09 to 0.47 ml/min at 6 months (p < .0001). Mean maximal mouth opening reduced from 45.58 to 42.53 mm at 6 months (p < .0001). 8.1% of subjects had some oral mucositis at 6 months, including 3.8% with oral ulceration. Mean overall pain score was unchanged. OH-QOL was reduced at 6 months, with changes related to dry mouth, sticky saliva, swallowing solid foods, and sense of taste (p ≤ .0001). At 6 months, there was greater frequency of using dental floss and greater proportion using supplemental fluoride (p < .0001). CONCLUSIONS: Despite advances in RT techniques, patients with HNC experience oral complications 6 months after RT, with resulting negative impacts on oral function and quality of life.

Tongue-out versus tongue-in position during intensity-modulated radiotherapy for base of tongue cancer: Clinical implications for minimizing post-radiotherapy swallowing dysfunction.

BACKGROUND: The purpose of this study was to assess whether different tongue positions change the radiation doses to swallowing organs at risks: the pharyngeal constrictor, oral cavity, and larynx during intensity-modulated radiotherapy (IMRT) for base of tongue (BOT) cancer. METHODS: IMRT plans with Tongue-out (IMRT-TO) and tongue-in position (IMRT-TI) was compared in 3 cases. RESULTS: Distance from BOT to pharyngeal constrictor was increased to 1.8 ± 0.8 cm with IMRT-TO from 0.9 ± 0.6 cm with IMRT-TI (P < .01). Compared to IMRT-TI, IMRT-TO significantly decreased the radiation dose to the anterior oral cavity, oral tongue, superior pharyngeal constrictor, middle pharyngeal constrictor, and supraglottic larynx (all P ≤ .04). IMRT-TO also had a smaller volume irradiated than IMRT-TI to the anterior oral cavity and the oral tongue receiving ≥30 Gy (V30) and V35, and superior pharyngeal constrictor and middle pharyngeal constrictor for V55 and V65 (all P ≤ .04). CONCLUSION: Dosimetric advantage with IMRT-TO over IMRT-TI may potentially reduce post-IMRT swallowing dysfunction in selected patients with BOT cancer.

Oral sensory dysfunction following radiotherapy.

OBJECTIVES/HYPOTHESIS: To assess differences in oral tactile sensation between subjects who have undergone radiation therapy (XRT) compared to healthy controls. STUDY DESIGN: Cross-sectional cohort comparison. METHODS: Thirty-four subjects with a history of XRT were compared with 23 healthy controls. There was no difference in age (P = .23), but there were slightly more males in the XRT cohort (P = .03). The mean (standard deviation) time after XRT completion was 3.84 (4.84) years. Fifty-six percent of the XRT cohort received chemotherapy. Using our previously validated methodology to measure oral tactile sensory threshold quantitatively with Cheung-Bearelly monofilaments, sensory thresholds of four subsites (anterior tongue, buccal mucosa, posterior tongue, soft palate) were compared for the two cohorts. RESULTS: Site-by-site comparisons showed higher forces were required for stimulus detection at all four subsites among subjects in the XRT cohort compared to healthy controls. Mean force in grams for XRT versus control cohorts were: anterior tongue, 0.39 (1.0) versus 0.02 (0.01); buccal mucosa, 0.42 (0.95) versus 0.06 (0.05); posterior tongue, 0.76 (1.46) versus 0.10 (0.07); and soft palate, 0.86 (1.47) versus 0.08 (0.05) (P < .001 for all comparisons). Combining all four subsites into a single metric to assess an overall level of oral tactile dysfunction, the XRT cohort had reduced sensation by 18.7 dB (P < .001). CONCLUSIONS: After radiation therapy, the oral cavity and oropharynx exhibit global tactile sensory dysfunction, manifested by increased tactile forces required for stimulus detection. The magnitude of sensory impairment is 18.7 dB. LEVEL OF EVIDENCE: 3b. Laryngoscope, 127:2282-2286, 2017.