Oral function in amyotrophic lateral sclerosis patients: A matched case-control study.

BACKGROUND & AIMS: Patients with amyotrophic lateral sclerosis (ALS) develop swallowing difficulties with the progression of the disease. The present study aimed at comparing oral function and body composition between ALS patients and healthy controls, and at evaluating which parameters are the most discriminant between both groups. METHODS: We included ALS patients at the start of their multidisciplinary follow-up at the Geneva University Hospitals and healthy age-, gender-, and dental status-matched adults. We assessed the severity of the disease through the ALS Functional Rating Scale and the swallowing difficulties through the EAT-10 score. We performed an intraoral examination of the dental status, and measured chewing performance, bite, lip and tongue force, saliva weight, and body composition. Group comparisons were performed with t-tests or Mann-Whitney tests as appropriate. Linear discriminant analysis was used to determine the most discriminant parameters between groups. RESULTS: Twenty-six ALS patients (bulbar onset: n = 7, median (IQR) ALS Functional Rating Scale: 37 (11)) were included. The ALS patients had a significantly lower chewing performance (p < 0.001), lip force (p < 0.001), tongue force (p = 0.002), saliva weight (p < 0.004) and fat-free mass index (p < 0.001) as compared to the healthy individuals, and a higher EAT-10 score (p < 0.001). In ALS patients, a low chewing performance was correlated with a low bite (r = -0.45, p < 0.05)) and tongue force (r = -0.59, p < 0.05). The most discriminant parameters between both groups, by order of importance, were chewing performance, fat-free mass index and saliva weight and allowed the calculation of a discriminant function. CONCLUSION: Compared to healthy controls, ALS patients have significant alterations of oral function and body composition. The most discriminant parameters between both groups were chewing performance, fat-free mass index and saliva volume. It remains to be demonstrated whether oral parameters predict outcome. CLINICAL TRIAL REGISTRY: clinicaltrials.gov, identifier: NCT01772888.

Safety and surgical outcomes of transoral endoscopic thyroidectomy vestibular approach for papillary thyroid cancer: A two-centre study.

OBJECTIVE: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been increasingly used to treat patients with papillary thyroid cancer (PTC) with improved cosmetic outcomes. This study aimed to explore the safety and efficacy of TOETVA in patients with PTC. MATERIALS AND METHODS: This retrospective study included TOETVA patients from Yantai Yuhuangding and Xiamen Zhongshan Hospitals. Among the 297 patients studied, 84 had benign nodules (28.3%), 208 had PTC (70.0%), and five had follicular thyroid cancer (1.7%). RESULTS: The incidence of transient and permanent recurrent laryngeal nerve injury was 1.3%, while that of transient hypoparathyroidism was 1.0%. Mental nerve paraesthesia was observed in 241 cases (81.1%), while permanent mental nerve paraesthesia was noted in seven cases (2.4%). Abnormal motor function of the lower lip and chin was observed in 12 cases (4.0%). Ten of the 208 patients with PTC (4.8%) underwent total thyroidectomy (TT) and bilateral central neck dissection (CND). A mean 6.6 ± 4.1 and 10.9 ± 4.0 lymph nodes were removed in the unilateral and bilateral surgeries, respectively, with a metastasis rate of 49.0%; a mean 2.7 ± 2.3 and 3.2 ± 2.6 lymph nodes were metastatic, respectively. The parathyroid gland was inadvertently removed in 6.6% and auto-transplanted in 10.6% of patients with unilateral PTC. The non-stimulated thyroglobulin level in the TT and bilateral CND patients was below 1 ng/mL at the 6-month follow-up. CONCLUSION: TOETVA is safe in well-selected patients with unilateral PTC. However, its safety remains unclear in patients treated with TT and bilateral CND.

Synkinetic Unilateral Lower Lip Palsy: Diagnosis and Technical Considerations for Facial Reanimation.

Importance: There are no universally adopted surgical techniques to treat depressor labii inferioris (DLI) dysfunction in patients with postfacial paralysis synkinesis. We describe a novel description of this disorder and technical surgical considerations for reanimation. Objective: To describe a new classification for DLI dysfunction and a surgical option to restore a natural appearing full dentition smile. Design: Surgical pearls-description of novel surgical technique. Setting: A private practice. Participants: Patients who underwent the operation.

Non-invasive ventilation with pursed lips breathing mode for patients with COPD and hypercapnic respiratory failure: A retrospective analysis.

PURPOSE: Long-term non-invasive ventilation (NIV) is recommended for patients with stable chronic obstructive lung disease (COPD) and chronic hypercapnia. High inspiratory pressure NIV (hiNIV) and a significant reduction of arterial pCO2 have been shown to prolong survival. Often, patients on hiNIV describe severe respiratory distress, known as "deventilation syndrome", after removal of the NIV mask in the morning. Mechanical pursed lips breathing ventilation (PLBV) is a new non-invasive ventilation mode that mimics the pressure-curve of pursed lips breathing during expiration. The clinical impact of switching patients from standard NIV to PLBV has not been studied so far. PATIENTS AND METHODS: In this hypothesis generating study, we retrospectively analysed the effects of switching COPD patients (stage GOLD III-IV) from conventional NIV to PLBV. Medical records of all patients who had an established NIV and were switched to PLBV between March 2016 and October 2017 were screened. Patients were included if they complained of shortness of breath on mask removal, used their conventional NIV regularly, and had a documented complete diagnostic workup including lung function testing, blood gas analysis and 6-minute walk test (6MWT) before and after 3-7 days of PLBV. RESULTS: Six male and 10 female patients (median age 65.4 years; IQR 64.0-71.3) with a previous NIV treatment duration of 38 months (median; IQR 20-42) were analysed. After PLVB initiation, the median inspiratory ventilation pressure needed to maintain the capillary pre-switch pCO2 level was reduced from 19.5 mbar (IQR 16.0-26.0) to 13.8 mbar (IQR 12.5-14.9; p<0.001). The median 6MWT distance increased from 200m (IQR 153.8-266.3) to 270m (IQR 211.3-323.8; p<0.001). Median forced vital capacity (FVC) increased from 49.5% to 53.0% of the predicted value (p = 0.04), while changes in FEV1 and residual volume (RV) were non-significant. CONCLUSION: Based on this small retrospective analysis, we hypothesise that switching patients with COPD GOLD III-IV and chronic hypercapnia from conventional NIV to PLBV may increase exercise tolerance and FVC in the short term.

Contralateral Depressor Labii Inferioris Chemodenervation for Congenital Unilateral Lower Lip Palsy.

INTRODUCTION: Congenital unilateral lower lip palsy - also known as asymmetric crying facies - is isolated asymmetry of the lower lip unilaterally. It is characterized by isolated lower lip asymmetry during smiling and speech. Although etiology is unknown, depressor labii inferioris (DLI) weakness is hold responsible. AIM: Purpose of this study was to evaluate the effectiveness of contralateral depressor labii inferioris botulinum toxin injection on patients' concern levels and patient satisfaction. Ten units of botulinum toxin A injection was carried out to the healthy contralateral side. METHODOLOGY: Eleven patients were treated. Patients' pretreatment and posttreatment concern regarding asymmetry during speech and smiling was evaluated with a questionnaire. Patients' perception of treatment satisfaction was also evaluated with a questionnaire. RESULTS: Mean score related to concern about asymmetric appearance during smiling decreased from 1.6 ±â€Š0.8 to 0.5 ±â€Š0.5. Mean score related to concern about asymmetric appearance during speech decreased from 1.6 ±â€Š0.5 to 0.4 ±â€Š0.5. Eleven out of 11 patients reported improvement with speech whereas 10 out of 11 patients reported improvement with smiling. No weakness about oral competence was reported. CONCLUSION: Most congenital unilateral lower lip palsy patients are concerned regarding their asymmetric appearance while smiling or speaking. Chemodenervation of the contralateral DLI muscle reduces concern levels and has high patient satisfaction. Chemodenervation of the contralateral healthy DLI muscle is a valid, practical treatment option.

[Position dependent dyspnea and cyanosis of the lips at the daily round - A case of Platypnea-Orthodeoxia Syndrome]. / Lageabhängige Dyspnoe und Lippenzyanose im Rahmen der täglichen Visite ­ Platypnoe-Orthodeoxie Syndrom.

HISTORY AND CLINICIAL FINDINGS: We elaborate a case of a 79-year-old patient who presented with position dependent shortness of breath and cyanosis of the lips at the daily round. INVESTIGATIONS: In supine position the patient's oxygen saturation was normal > 95 %, in upright position we noticed a reproducible decrease to 76-85 %. Echocardiographic examination revealed a patent foramen ovale (PFO) with spontaneous right-left shunt and additionally a thoracic aortic aneurysm. DIAGNOSIS: Due to a typical position dependent cyanosis, dyspnea and decreased oxygen saturation in combination with patent foramen ovale and aortic aneurysm, Platypnea-Orthodeoxia Syndrome was our suspected diagnosis. TREATMENT AND COURSE: After percutaneously occlusion of the foramen ovale the patient presented symptom-free und oxygen saturation remained stable in supine and upright positions. In the follow up examination a significant right-left shunt could no longer be found. CONCLUSION: The combination of position dependent shortness of breath and decreased oxygen saturation should lead to the diagnosis of Platypnea-Orthodeoxia Syndrome. The underlying reasons are diverse and not only of cardiologic origin.

A Case Report on Stomatitis Venenata Due to the Use of Lip Balm.

INTRODUCTION: Allergic reactions can manifest in various forms ranging from mild, almost unnoticeable reactions to life threatening anaphylaxis. Stomatitis venenata or contact stomatitis is described as a contact allergy of the oral mucosa which can occur due to repeated contact with the causative agent. Dental and cosmetic products, dental materials and dental therapeutic agents are the common allergens of the oral cavity. These allergies show varied clinical presentations, from swelling, pain, burning sensations to vesiculation, ulcerations, crusting and sloughing. Contact stomatitis due to cosmetic products have been on a rise recently due to the ease of availability and increase in their usage among individuals. AIM: The aim of this article is to present a case reports on an allergic reaction in a 17-year-old female triggered by the use of cosmetics. CASE REPORT: In the present article, we report a case of stomatitis venenata due to lip balm in a 17-year-old female for its rarity. CONCLUSION: Stomatitis venenata is a rare allergic condition that causes significant morbidity in an affected individual. Prompt recognition and elimination of the causative allergen followed by an appropriate therapy would help in complete resolution of this condition.

Effect of Impairment-Oriented and Function-Oriented Exercises on Mouth Function in Subjects with Systemic Sclerosis.

PURPOSE: The aim of this study was to develop an exercise protocol to improve maximal mouth opening (MMO), tongue protrusion (Tprot), tongue strength (Tstren), and lip strength (Lstren), and to assess its effects on subjects with scleroderma. METHODS: We performed four replicated single-system studies in a consecutive sample of subjects with scleroderma. An instrumented assessment measured MMO, Tprot, Tstren, and Lstren. Each day, subjects were assessed and performed orofacial exercises conducted by speech therapists. Treatments were first aimed at improving mouth physical characteristics by impairment-oriented exercises and then to improve skills with function-oriented exercises. RESULTS: The mean phase differences between assessment and treatment phases across subjects were from 0.88 to 9.56 mm in MMO, from 2.03 to 12.3 mm in Tprot, from -0.12 to 5.35 N in Tstren, and from -0.84 to 5.19 N in Lstren. After treatment, 3 subjects crossed the 5th percentile discriminating normal from abnormal performances for both Tstren and Tprot, while this occurred in 2 subjects for MMO and Lstren. CONCLUSIONS: The results of this study suggest that rehabilitation appears to be useful in reducing tongue and lip impairments and in improving oral functions in subjects with scleroderma.

A speech measure for early stratification of fast and slow progressors of bulbar amyotrophic lateral sclerosis: lip movement jitter.

Objective: To assess the utility of novel measures derived from a rapid syllable repetition task (i.e. oral dysdiadochokinesis [DDK]) in early stratification of fast and slow progressive bulbar amyotrophic lateral sclerosis (ALS) and prediction of bulbar disease progression rate. Methods: Fifty-four individuals with ALS were tracked longitudinally on their oral DDK and global bulbar/speech performance (i.e. bulbar subscore on the ALS Functional Rating Scale-Revised [ALSFRS-R]; articulation rate during passage reading) for a four-month average duration. Based on the bulbar deterioration rate over the tracked period, the participants were stratified as 14 fast bulbar progressors and 40 slow bulbar progressors using a posteriori classification approach. To determine if oral DDK performance predicts the differential bulbar disease progression trajectories in these individuals during the early stages of the tracked period (prior to significant bulbar/speech signs), twenty-two measures of lip motor performance in an oral DDK task were derived to (1) differentiate fast and slow bulbar progressors using the Receiver Operating Characteristic analysis and (2) predict bulbar disease progression rates across all individuals using linear regressions. Results: Movement jitter, a measure of temporal variability of alternating lip movement during DDK, showed 80% sensitivity and 95% specificity in differentiating fast and slow bulbar progressors early in the disease, and outperformed the ALSFRS-R bulbar subscore and articulation rate. Movement jitter also predicted bulbar disease progression rates across participants. Conclusion: Findings provided preliminary validation of the clinical value of movement jitter during oral DDK in patient stratification and bulbar disease prognosis.

Lipofilling in patients with a cleft lip (and palate) - a pilot study assessing functional outcomes and patients' satisfaction with appearance.

INTRODUCTION: Lipofilling of the upper lip as secondary treatment in patients with a cleft lip (and palate) (CL ±â€¯P) has been proposed to improve projection and volume especially in profile view. The purpose of the present study was to document differences in functional (i.e. logopaedic) and self-reported aesthetic outcomes by comparing pre- and postoperative results after lipofilling of the upper lip in patients with CL ±â€¯P. METHODS: Eight Dutch-speaking youngsters and young adults (three women, five men) with CL ±â€¯P were included. The median age was 19 years (range: 14-24 years). Logopaedic outcomes (i.e. assessment of orofacial myofunctional behavior, articulation and lip strength) and self-reported aesthetic outcome (i.e. patients' satisfaction using the Cleft Evaluation Profile) were determined. RESULTS: Neither for lip strength and orofacial myofunctional behavior nor for articulation statistically significant differences were found when comparing measurements before and after lipofilling. Regarding patients' satisfaction, a statistically significant increased self-evaluation of appearance in profile was found after lipofilling. CONCLUSION: Regarding functionality, the present study did not find any differences when comparing outcomes before and after lipofilling. Nevertheless, patients were more satisfied with appearance in profile after performance of this technique. As this is a small sample study, further research and long-term follow-up studies are necessary.

Hyaluronic acid and platelet-rich plasma, a new therapeutic alternative for scleroderma patients: a prospective open-label study.

BACKGROUND: Systemic sclerosis is a systemic connective tissue disease characterized by endothelium damage, fibrosis, and subsequent atrophy of the skin. Perioral fibrosis produces a characteristic microstomia together with microcheilia, both of which cause severe difficulties and affects patients' daily life, such as eating and oral hygiene. Since there are no effective and specific therapies, we have aimed at evaluating the response to filler injections of hyaluronic acid together with platelet-rich plasma. METHODS: Ten female patients aged between 18 and 70 were included in this study. Each patient was treated with three filler injections of hyaluronic acid and platelet-rich plasma at an interval of 15 to 20 days. Follow-up check-ups were recorded 1, 3, and 24 months after the end of the treatment. During the therapy and the subsequent follow-up, we evaluated the mouth's opening, freedom of movement of the lips, and skin elasticity. RESULTS: After the treatment, patients had achieved good results already after the first injection and the improvement was maintained in the following months, up to 2 years. In particular, 8 (80%) patients showed a greater mouth's opening and increased upper lip's thickness during 1-month follow-up and maintained these results after 2 years (maximum mouth's opening T0 47.61; T3 49.23; T4 48.60 p <  0.0001. Upper lip's thickness T0 4.20; T3 4.75; T4 4.45 p <  0.0001). Moreover, distance between upper and lower incisors (T0 27.05; T3 29.03; T4 28.14 p < 0.0001), inter-commissural distance (T0 49.12; T3 51.44; T4 50.31: p < 0.0001), and lower lip's thickness (T0 3.80; T3 4.85, 5.10; T4 4.25; p < 0.0001) were increased in all of patients in 1-month follow-up, keeping these benefits after 24 months and having a significant increase of skin elasticity 1 month after the end of therapy. CONCLUSIONS: Our study demonstrates that filler injections of hyaluronic acid and platelet-rich plasma represent an efficient local therapeutic alternative for patients affected by scleroderma. The treatment has significantly improved patients' quality of living.

Neural ensemble dynamics in dorsal motor cortex during speech in people with paralysis.

Speaking is a sensorimotor behavior whose neural basis is difficult to study with single neuron resolution due to the scarcity of human intracortical measurements. We used electrode arrays to record from the motor cortex 'hand knob' in two people with tetraplegia, an area not previously implicated in speech. Neurons modulated during speaking and during non-speaking movements of the tongue, lips, and jaw. This challenges whether the conventional model of a 'motor homunculus' division by major body regions extends to the single-neuron scale. Spoken words and syllables could be decoded from single trials, demonstrating the potential of intracortical recordings for brain-computer interfaces to restore speech. Two neural population dynamics features previously reported for arm movements were also present during speaking: a component that was mostly invariant across initiating different words, followed by rotatory dynamics during speaking. This suggests that common neural dynamical motifs may underlie movement of arm and speech articulators.

Swallowing apraxia in a patient with recurrent ischemic strokes: A case report.

RATIONALE: Swallowing apraxia is defined as dysfunction in oral phase caused by the deficit in the coordination of tongue, lip, and chin movements, without motor weakness, sensory loss, and cognitive decline and has not been reported yet. PATIENT CONCERNS: A 69-year-old male with personal medical history of ischemic stroke about 10 years ago newly developed right striatocapular infarction. He had a problem in the oral phase of swallowing after recurrent ischemic strokes. DIAGNOSES: He was diagnosed as swallowing apraxia via bed side examination and videofluoroscopic swallowing study. INTERVENTION: Videofluoroscopic swallowing study was done in this case. OUTCOMES: Symptoms and findings of VFSS were not improved after 2 months treatment. LESSONS: This case implies that a clinician should be alert to swallowing apraxia as a possible cause when a patient with recurrent strokes complains of oral phase dysfunction of swallowing and considers proper diagnostic option such as videofluoroscopic swallowing study.

Variation of upper lip pressure on upper teeth during non-extraction orthodontic treatment: A prospective clinical study.

OBJECTIVE: The objectives of this prospective clinical study are to quantify the variation of pressure exerted by the upper lip on the upper teeth during the alignment phase and to evaluate its capacity to adapt to changes in dental position. MATERIALS AND METHODS: Thirty young subjects in skeletal Class I relationship requiring non-extraction orthodontic treatment were included in this study. The pressure exerted by the upper lip on the upper central incisors and right canine were measured during rest and swallowing positions using a pressure transducer before bracket placement (T0), after bracket placement (T1), three months (T2) and six months later (T3). Maxillary intercanine width (CC), upper arch length (U) and crowding (C) were measured on stone models at T1, T2 and T3 to determine the existence of a correlation between the variation of lip pressure and these variables. RESULTS: The lip pressure significantly increased after bracket placement and remained relatively stable during the six-month period. The labial pressure on the incisors was the only variable to significantly decrease at T3, though remaining significantly higher than the starting pressure. A positive correlation was found between the variation of the inter-canine distance and the labial pressure on the canine at rest whereas a negative correlation exists between the crowding and the labial pressure on the incisors at rest. CONCLUSION: This study showed that increasing inter-canine width disrupts the muscle equilibrium and therefore is prone to relapse, whereas the upper lip can better adapt to the protrusion of upper incisors.

Fractional CO2 laser treatment for post-surgical lip scars in cleft lip and palate patients.

Post-surgical scars of cleft lip patients can lead to abnormal lip activity, which causes deficient maxillary growth. The aim of the present study was to assess the effect of laser therapy on the appearance and electrical activity of the upper lip in cleft lip and palate patients. Twelve patients with cleft lip and palate participated in this study. All patients had surgically repaired the cleft lip at the age of about 3-6 months. The lip scars underwent five fractional CO2 laser treatment sessions with a 4-week interval. Improvement of the quality of the skin texture was recorded according to quartile grading scale based on photographs taken before and 1 month after treatment. Patients' satisfaction survey was also recorded using Patient Scar Assessment Questionnaire (PSAQ) before and after laser therapy. Moreover, the EMG activity of the upper lip muscle was measured before and after treatment. According to dermatologists, the improvement of scar appearance ranged from 0.5 to 3, with a mean of 1.29 ± 0.86. Mean scores of the scar appearance (p < 0.001), symptoms (p = 0.003), and scar consciousness (p < 0.001) subscales of the PSAQ questionnaire had significantly increased after treatment. The EMG recording of the upper lip had decreased significantly after laser treatment at rest (p = 0.009) and maximum lip compression (p = 0.007). The fractional CO2 laser is an effective method for treating old scars of the cleft lip with a significant change in the opinion of patients about their scar appearance. Also, the therapy can help to reduce the EMG activity of the upper lip at rest.

Traumatic dental injuries in preschool-age children: Prevalence and risk factors.

This study examined the prevalence, socio-demographic correlates, and clinical predictors of traumatic dental injuries (TDIs) in the primary dentition among a community-based sample of preschool-age children. The sample comprised 1,546 preschool-age children (mean age 49 [range: 24-71] months) in North Carolina public preschools, enrolled in a population-based investigation among young children and their parents in North Carolina. Information on socio-demographic, extraoral, and intraoral characteristics was collected and analyzed with bivariate and multivariate methods, including logistic regression modeling and marginal effects estimation. The prevalence of dental trauma was 47% and 8% of TDI cases were "severe" (pulp exposure, tooth displacement, discolored or necrotic tooth, or tooth loss). In bivariate analyses, overjet and lip incompetence were significantly associated with TDI. Overjet remained positively associated with severe trauma in multivariate analysis, OR = 1.4, 95% confidence interval (CI) [1.2, 1.6], corresponding to an absolute 1.3%, 95% CI [0.7, 1.8], increase in the likelihood of severe trauma, per millimeter of overjet. Children with increased overjet (>3 mm) were 3.8, 95% CI [2.0, 7.4], times as likely to have experienced severe TDI compared with those with ≤3 mm. Overjet is a strong risk factor for TDIs in the primary dentition. Incorporating and operationalizing this information may help TDI prevention and related anticipatory guidance for families of preschool-age children.

"Three Subunit" Classification of Lesser-Form Cleft Lip and Muscle Analysis and Reconstruction of These Subunits Based on the Microanatomic Structures of Muscles in the Normal Upper Lip.

BACKGROUND: The main phenotypic features of lesser-form cleft lip include nasal, philtrum, and vermilion deformities. The manifestations of lesser-form cleft lip vary greatly, and it is difficult to rebuild these subunits during the operation. METHODS: "Three subunits" classification of lesser-form cleft lip was identified as nasal deformity (N), philtrum deformity (P), or vermilion deformity (V); and slight deformity (0) or obvious deformity (1). A total of 200 patients with lesser-form cleft lip were classified into one of the following 8 types: N1P1V1, N1P1V0, N0P1V1, N1P0V1, N0P0V1, N1P0V0, N0P1V0, or N0P0V0. Then the authors discussed the deformities of the lesser-form cleft lip and the reconstruction of the muscles in these subunits based on the microanatomic structure of the nasolabial muscle. RESULTS: This retrospective review included 200 patients with a lesser-form cleft lip, who were seen at our center from 2015 to 2017. There were 149 (74.5%) N1P1V1, 11 (5.5%) N1P1V0, 13 (6.5%) N0P1V1, 4 (2.0%) N1P0V1, 8 (4.0%) N0P0V1, 10 (5.0%) N1P0V0, 1 (0.5%) N0P1V0, and 4 (2%) N0P0V0 clefts. The various deformities of nasal floor, philtrum ridge, and vermilion may suggest that the muscle bundles in these subunits are abnormal and the operation should be performed to simulate the running directions and tension lines of these local muscles. CONCLUSIONS: The microanatomic structure and the tension lines of the nasolabial muscles can provide new perspectives for better understanding and repairing the lesser-form cleft lip in subunits.