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1.
J Appl Oral Sci ; 29: e20200932, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34105693

RESUMO

Third molar removal surgery usually comes accompanied by postoperative discomfort, which could be influenced by the surgical approach chosen. This scoping systematic review aimed at compiling the available evidence focused on the influence of flap design, including envelope flap (EF), triangular flap (TF), and modified triangular flap (MTF), on postoperative pain, swelling, and trismus, as primary outcome measures, and any result mentioning healing promotion or delay, as secondary outcome measure, after mandibular third molar extraction surgery. An electronic search, complemented by a manual search, of articles published from 1999 to 2020 was conducted in the Medline (PubMed), EMBASE and Web of Science databases including human randomized controlled trials, prospective, and retrospective studies with at least 15 patients. The risk of bias of the included studies was assessed either with the Cochrane's Risk of Bias tool or with the Newcastle-Ottawa scale. Every step of the review was performed independently and in duplicate. The initial electronic search recovered 2102 articles. After applying the inclusion criteria, 12 articles were included. For patient's perceived postoperative pain, TF and MTF frequently reported better results than EF. For swelling, the literature is divided, despite a trend favoring EF. For trismus, data showed that its occurrence is mostly associated with the duration of the surgery rather than with the chosen flap. For healing, the limited data is inconclusive. Finally, randomized studies showed a high risk of bias, whereas nonrandomized studies were mostly of good quality and low risk of bias. Although there was no clear consensus regarding the influence of different flap designs for third mandibular molar extraction on postoperative clinical morbidities; the surgeon's experience, estimated surgical difficulty, molar position and orientation, and surg ery duration should be considered when choosing among the different flap designs.


Assuntos
Dente Impactado , Trismo , Edema/etiologia , Humanos , Mandíbula , Dente Molar , Dente Serotino/cirurgia , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias , Estudos Prospectivos , Estudos Retrospectivos , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Trismo/etiologia
2.
BMJ Case Rep ; 14(5)2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059547

RESUMO

Intracranial extension of acquired cholesteatoma is a rare occurrence that can develop secondary to trauma, chronic otitis media or acquired aural cholesteatoma. The most commonly observed symptoms are headache and hearing loss. The authors report on a rare case of intracranial cholesteatoma presenting with atypic symptoms: swelling and temporomandibular joint disorders.


Assuntos
Colesteatoma da Orelha Média , Perda Auditiva , Otite Média , Transtornos da Articulação Temporomandibular , Colesteatoma da Orelha Média/complicações , Colesteatoma da Orelha Média/diagnóstico por imagem , Colesteatoma da Orelha Média/cirurgia , Humanos , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/etiologia , Trismo/etiologia
3.
Anesth Prog ; 68(2): 117-118, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34185859

RESUMO

Juvenile hyaline fibromatosis (JHF) is a rare autosomal recessive disease characterized by the presence of tissue nodules, joint contractures, and gingival hyperplasia. With a 1-year-9-month-old female patient scheduled for a gingivectomy and excision of a lower lip mass under general anesthesia, it was anticipated that airway management would be difficult because of trismus and limited cervical movement. Intubation with video-laryngoscopic assistance could not be achieved because gingival hyperplasia and trismus prevented blade insertion and manipulation. Therefore, 2 endotracheal tubes were used: 1 used as a nasopharyngeal airway for assisted ventilation, and 1 used for intubation along with a flexible fiberoptic scope. This case demonstrated a useful method for managing ventilation and intubation in patients with JHF, particularly when the use of oral airway devices is difficult.


Assuntos
Anestésicos , Hialinose Sistêmica , Feminino , Humanos , Lactente , Trismo/etiologia , Trismo/terapia
4.
Age Ageing ; 50(5): 1861-1862, 2021 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115833

RESUMO

While tetanus is now a rare disease in the UK, it remains an important differential diagnosis for trismus and muscle spasms. Even more so in older adults, as this population is less likely to have received full vaccination. Hence, the highest incidence of tetanus in England is seen in older adults. Written informed consent for publication of their clinical details was obtained from the patient proxy.


Assuntos
Transtornos de Deglutição , Delírio , Tétano , Idoso , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Humanos , Espasmo/diagnóstico , Tétano/diagnóstico , Trismo/diagnóstico , Trismo/etiologia
5.
Ann Ital Chir ; 92: 116-118, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34031281

RESUMO

Trismus is defined as a tonic contraction of the muscles of mastication. It can also refer to limited mouth opening of any cause. Trismus is a classical symptom of masticatory space infections and it can be a sign of an infection in the anterior compartment of lateral pharyngeal space. Common causes in clinical practice followed by trismus are odontogenic infection which can be periodontal or pericoronal. This article will present a clinical report on intraoral management of mandibular odontogenic infection accompanied by severe trismus under local anesthesia using modified Akinosi technique in an outpatient environment. Treatment and postoperative period were routine. This kind of approach provides access to the infection at an early stage without general anesthesia, it shortens the hospital treatment and it enables faster recovery. KEY WORDS: Local Anesthesia, Odontogenic infection, Trismus.


Assuntos
Anestesia Local , Antibacterianos/uso terapêutico , Doenças Estomatognáticas/tratamento farmacológico , Doenças Estomatognáticas/cirurgia , Trismo , Adulto , Anestesia Local/métodos , Humanos , Masculino , Boca , Doenças Estomatognáticas/complicações , Doenças Dentárias/tratamento farmacológico , Doenças Dentárias/cirurgia , Raiz Dentária/cirurgia , Trismo/etiologia , Trismo/terapia
6.
Integr Cancer Ther ; 20: 15347354211006474, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34014116

RESUMO

BACKGROUND: Current treatment for head and neck cancers (HNCs) have led to an improved survival. However, the sequelae of cancer treatment often result in trismus, or reduced mouth opening. The purpose of this report is to identify interventional studies for trismus management in HNC patients. METHODS: A search of PubMed, Embase, Cumulated Index to Nursing and Allied Health Literature, and the Cochrane Library was conducted in March 2020 for randomized controlled trials (RCTs) involving interventions for trismus for head and neck cancer within 10 years. Intervention could involve the use of an exercise regime, jaw rehabilitation device, technological device, medication or massage therapy. The primary outcome was the measurement of mouth opening. RESULTS: Eleven RCTs involving a total of 685 patients with HNC were included. Six RCTs evaluated the effectiveness of a jaw mobilization device with exercises; there was no significant benefit of an exercise regime with a jaw mobilization device either initiated before, during or after treatment compared to no exercise. Two RCTs compared 2 intervention groups that involved exercises only, with 1 study assessing the benefit of weekly supervised physical therapy with gum chewing and another evaluating the benefit of immediate (1-2 days) versus delayed (7-10 days) initiation of exercise post-surgery; there was no significant difference between groups in either study. One RCT that recruited only patients with trismus demonstrated that an exercise regime in combination with low-level laser therapy or low-intensity ultrasound had superior results in mouth opening measurements compared to exercise alone. Two RCTs compared intervention groups with and without follow-up reminders; both studies showed a significant improvement in mouth opening measurements in groups with follow-up reminders. CONCLUSION: This systematic review did not convey a clear consensus as to optimal intervention for trismus in HNC patients. A variety of exercise regimens and jaw rehabilitation devices appear to have comparable effectiveness. However, efforts focused on increasing adherence to a particular intervention protocol may positively impact mouth opening measures in head and neck cancer patients. Also, low-level laser therapy and low-intensity ultrasound coupled with exercise may be beneficial for patients with trismus.


Assuntos
Neoplasias de Cabeça e Pescoço , Trismo , Terapia por Exercício , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Trismo/etiologia , Trismo/terapia
7.
J Oral Maxillofac Surg ; 79(9): 1829-1836, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33872601

RESUMO

PURPOSE: Methylprednisolone is widely administered after impacted third molar surgery. This study compared the effect of methylprednisolone injection into the masseter and gluteal muscle on pain, edema, and trismus after impacted lower third molar surgery. METHODS: This was a single-blind placebo-controlled randomized clinical trial. Sixty patients with an impacted lower third molar were included and randomly assigned into 3 groups. Each group received 1 of the following medications half an hour before surgery: Group I: 40 mg methylprednisolone injected into masseter muscle; Group II: 40 mg methylprednisolone injected into gluteal muscle; Group III: considered as control group with no intervention. The level of pain was recorded 1, 5, and 7 days after surgery using visual analog scale, and the amount of edema was measured 5 and 7 days after surgery using ultrasound imaging. The amount of trismus was measured 5 and 7 days after surgery based on the distance between incisor edge of upper and lower centrals. Friedman test was used to compare the level of pain, trismus and edema in each group at different times. Kruskal-Wallis test was used to compare the level of pain, trismus and edema among different groups at each time. Significance level was set at P < .05. RESULTS: There was no significant difference among the 3 groups (a total of 60 patients (31 females and 29 males), aged 19 to 35 years) considering edema (P = .250, CI = 0.22 ± 0.42), trismus (P = .337, CI = -5.93 ± 2.22) and pain (P = .285, CI = -2.91 ± 0.40) relief. CONCLUSIONS: Postsurgical pain, edema, and trismus were not reduced by intramuscular injection of methylprednisolone before third molar surgery.


Assuntos
Dente Serotino , Dente Impactado , Método Duplo-Cego , Edema/etiologia , Edema/prevenção & controle , Feminino , Humanos , Masculino , Músculo Masseter/diagnóstico por imagem , Metilprednisolona/uso terapêutico , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Método Simples-Cego , Extração Dentária , Dente Impactado/cirurgia , Trismo/etiologia , Trismo/prevenção & controle
8.
Med Oral Patol Oral Cir Bucal ; 26(3): e269-e275, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33772570

RESUMO

BACKGROUND: The extraction of impacted third molar teeth is a common procedure in maxillofacial surgery. The aim of this study was to compare of piezoelectric surgical technique with the one with conventional rotary instruments in terms of edema, trismus and pain, in mandibular third molar surgery. MATERIAL AND METHODS: 20 individuals with symmetrically impacted lower mandibular third molars and 40 teeth were included in the study. Third molars on the left side of each patient were removed with piezosurgery, while the counterparts on the right side were removed with conventional rotary instruments. Postoperatively, the same antibiotic, analgesic, and mouthwash were recommended to both groups. Ultrasound, edema, trismus measurements were performed before surgery, postoperative, postoperative day 2 and postoperative day 7. VAS scale was used to evaluate the pain. RESULTS: The average age of 20 individuals included in the study was found to be 21.85 ± 3.08 years. The operation time of the individuals who underwent the surgery with conventional rotary instruments was found to be 12 minutes 31.70 ± 167.03 seconds, and the operation time in the Piezosurgery group was 19 minutes 10.60 ± 306.59 seconds. There was no significant difference between the two groups in terms of trismus, edema, and pain. CONCLUSIONS: Piezosurgery is a safe method that can be used in molar removal, but in this split-mouth study, it is not found advantageous in terms of postoperative morbidity due to the longer working time compared to the one performed with conventional rotary instruments.


Assuntos
Dente Serotino , Dente Impactado , Adulto , Edema/epidemiologia , Edema/etiologia , Humanos , Mandíbula/cirurgia , Dente Molar , Dente Serotino/cirurgia , Morbidade , Boca , Dor Pós-Operatória/etiologia , Extração Dentária , Dente Impactado/cirurgia , Trismo/epidemiologia , Trismo/etiologia , Adulto Jovem
9.
BMC Oral Health ; 21(1): 91, 2021 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653320

RESUMO

BACKGROUND: Serratiopeptidase has been clinically used in controlling surgical and non-surgical inflammatory conditions. This study was conducted to assess the therapeutic effect of Serratiopeptidase in patients undergoing surgical removal of impacted mandibular third molar. METHODS: This randomized clinical trial investigated the efficacy of Serratiopeptidase and Paracetamol after surgical removal of impacted third molar for 5 days (n = 67) as compared with an equivalent dose of placebo and Paracetamol (n = 66). Outcome measures were reported pain, trismus and swelling using Laskin method. All outcome measures were recorded on days 0, 1, 2, 4, and 5 post-surgeries. RESULTS: In this clinical trail 133 patients (mean age 23 years, 54% female) completed the study. Baseline characteristics were comparable across treatment groups. Serratiopeptidase significantly improved trismus compared with control on the 4th day (27.30 ± 7.3 mm and 32.06 ± 7.7 mm, respectively (P < 0.001) Swelling markedly improved, The distance from the lower edge of the earlobe to the midpoint of the symphysis for cases vs control were 111.49 ± 8.1 mm and 115.39 ± 9.9 mm, respectively (P < 0.001). Reported pain, showed no statistical significance difference. CONCLUSION: Serratiopeptidase resulted in better inflammation improvement than placebo over 5 days. Further studies are warranted to assess longer-term and clinical outcomes, as well as safety. CLINICAL RELEVANCE: Serratiopeptidase administered postoperatively helps in improving trismus and swelling after removal of impacted lower third molars. Trial registration The study was registered in ClinicalTrial.gov under the number NCT02493179. Registered 1st of June 2015, https://clinicaltrials.gov/ct2/results?cond=serratiopeptidase .


Assuntos
Dente Serotino , Dente Impactado , Adulto , Método Duplo-Cego , Edema/etiologia , Edema/prevenção & controle , Feminino , Humanos , Masculino , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Peptídeo Hidrolases , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Resultado do Tratamento , Trismo/etiologia , Trismo/prevenção & controle , Adulto Jovem
12.
BMC Oral Health ; 21(1): 77, 2021 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-33602198

RESUMO

BACKGROUND: The effect of low-level laser therapy (LLLT) on pain mitigation following the third molar surgery is still controversial. The absence of a standard method for using laser among the studies is related to the types of sample selection, sample size, control, and LLLT parameters, which make pain mitigation following surgery more controversial. Therefore, this study aimed to determine the effect of LLLT on reducing pain, swelling, and trismus following the mandibular impacted third molar surgery. METHODS: This study was performed on 25 healthy subjects. After the surgery, amoxicillin 500 mg was prescribed every 8 h for a 7-day period besides oral Ibuprofen (Gelofen) 400 mg every 12 h for a 3-day period. The intraoral Laser diode 940 nm was applied immediately after suture on the tested side, while on the placebo side, a fiber tip was used with no laser radiation following surgery. Eventually, the pain score was evaluated by VAS index from the 1st to the 7th-day post-surgery and then analyzed by SPSS 24. RESULTS: The results indicate that the mean swelling and trismus before, during, 2 days after, and 7 days after the intervention did not differ significantly between the two studied groups. However, the results show that on the sixth and seventh days, the pain was significantly lower in the intervention group compared to the control group. CONCLUSIONS: The results suggest that although the pain, swelling, and trismus following surgery were lower on the radiated side, only pain was found to be significant on the radiated side (p < 0.05). The registration number of the clinical trial in a Primary Registry in the WHO Registry Network is IRCT20141209020258N110 and the date of retrospective registration is 04/05/2019. The related URL is https://www.irct.ir/trial/36321 .


Assuntos
Terapia com Luz de Baixa Intensidade , Dente Impactado , Método Duplo-Cego , Edema/etiologia , Edema/prevenção & controle , Humanos , Dente Serotino/cirurgia , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Extração Dentária , Dente Impactado/cirurgia , Trismo/etiologia , Trismo/prevenção & controle
13.
J Oral Maxillofac Surg ; 79(5): 981-988, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33561426

RESUMO

PURPOSE: This study aimed to evaluate the anti-inflammatory effect of oral dexamethasone 4 mg in a single dose preemptively administered to reduce pain, swelling, and trismus following mandibular third molar surgeries. METHODS: A split-mouth randomized clinical trial was performed including 22 participants undergoing surgical removal of bilateral and symmetrically positioned third molars. A total of 44 teeth were allocated by simple randomization to either the test or nonintervention/control side. Oral dexamethasone 4 mg was administered on the test side an hour before the surgery. All of the participants were unaware of the medication studied, and only 1 surgeon, blinded to the medication intake, performed all of the procedures. Anti-inflammatory effect was evaluated using the clinical parameters of mouth opening, swelling, and rescue analgesic medication intake to control pain. The statistical analysis was blinded to the allocation groups, and a significance value P < .05 was adopted for all the tests. RESULTS: Dexamethasone reduced the mean of rescue analgesic medication intake by 5 times (P = .002). Facial swelling was lower on the test side by 72h postsurgery in comparison with the control side (P = .036). No significant difference in mouth opening was found between the groups. CONCLUSIONS: Preemptive use of oral dexamethasone 4 mg proved to be effective in controlling pain and reducing the need for rescue medication and had a beneficial effect in reducing swelling during a short postoperative period.


Assuntos
Dente Serotino , Dente Impactado , Anti-Inflamatórios/uso terapêutico , Dexametasona/uso terapêutico , Edema/tratamento farmacológico , Edema/prevenção & controle , Humanos , Dente Serotino/cirurgia , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Extração Dentária , Trismo/tratamento farmacológico , Trismo/etiologia , Trismo/prevenção & controle
14.
Pediatr Blood Cancer ; 68(4): e28918, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33507629

RESUMO

BACKGROUND: Although metastatic involvement of bony sites including cranial bones is common in neuroblastoma (NB), mandibular metastases (MM) are uncommon, and specific outcomes have not been reported upon in the modern therapeutic era. METHODS: In this retrospective study, medical records on patients with MM from NB were reviewed. Statistical analysis was performed using the Kaplan-Meier method. RESULTS: Of 29 patients, nine (31%) had MM at diagnosis, whereas in 20 (69%) MM were first detected at NB relapse at a median time of 26 (6-89) months from diagnosis. Median maximal diameter of lesions was 3 (range 0.8-4.9) cm. MM were unilateral in 83% of patients, with ascending ramus (55%) and mandibular body (38%) being the two most common sites. All patients received systemic chemotherapy, and 26 (93%) patients received radiotherapy to MM. At a median follow-up of 37.3 (24.2-219.5) months, eight of nine patients with MM at diagnosis did not experience mandibular progressive disease. Eighteen of 20 patients with MM at relapse received therapeutic radiotherapy; objective responses were noted in 78%. Seventy-two percent (5/18) had not experienced relapse within the radiation field at a median of 12 (2-276) months postradiotherapy. Dental findings at follow-up after completion of NB therapy included hypodontia, hypocalcification of enamel, and trismus. Median 3-year overall survival in patients with relapsed MM was 51 ± 12% months from relapse. CONCLUSION: MM when detected at diagnosis is associated with a prognosis similar to that for other skeletal metastases of NB. Radiotherapy is effective for control of MM detected both at diagnosis and relapse. Significant dental abnormalities posttherapy warrant regular dental evaluations and appropriate intervention.


Assuntos
Mandíbula/patologia , Neoplasias Mandibulares/secundário , Neuroblastoma/patologia , Adolescente , Adulto , Anodontia/etiologia , Criança , Pré-Escolar , Dentição , Feminino , Humanos , Lactente , Estimativa de Kaplan-Meier , Masculino , Mandíbula/efeitos dos fármacos , Mandíbula/efeitos da radiação , Neoplasias Mandibulares/tratamento farmacológico , Neoplasias Mandibulares/patologia , Neoplasias Mandibulares/radioterapia , Neuroblastoma/tratamento farmacológico , Neuroblastoma/radioterapia , Estudos Retrospectivos , Trismo/etiologia , Adulto Jovem
15.
Artigo em Inglês | MEDLINE | ID: mdl-33419167

RESUMO

Non-infectious complications such as post-extraction pain, trismus, and swelling are extremely common after impacted wisdom tooth removal. The aim of the study was to assess the impact of using kinesio tape on the level of the postoperative swelling of soft tissues, trismus, and pain in patients undergoing the surgical extraction of an impacted mandibular third molar. One hundred patients undergoing the surgical extraction of a lower wisdom tooth were randomly divided into two groups: a study group with kinesio taping (KT) (n = 50) and a control group without kinesio taping (NKT) (n = 50). The surgical procedure was performed according to the same repeatable scheme. Kinesio tape was applied immediately after surgery in the KT group. In both groups, measurements of swelling, trismus, and pain were performed before the surgery and on the third and seventh postprocedural days. Kinesio tape had a significant effect on the decrease in facial swelling on the third day after surgery and a decrease in trismus and pain severity levels on the third and seventh days after surgery. The kinesio tape method is non-invasive, continuously active throughout the entire application period, and requires no additional patient appointments. KT application is an effective method for reducing postoperative edema, pain, and trismus after impacted mandibular wisdom teeth surgery.


Assuntos
Fita Atlética , Dente Impactado , Humanos , Dente Serotino/cirurgia , Dor Pós-Operatória , Dente Impactado/cirurgia , Trismo/etiologia
16.
Br J Oral Maxillofac Surg ; 59(2): 191-196, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33483157

RESUMO

We undertook this study to assess the analgesic and anti-inflammatory properties of ibuprofen when administered through two drug delivery systems after mandibular third molar surgery. The study was conducted on 100 patients who required the surgical removal of impacted mandibular third molars under local anaesthesia. The study subjects were divided into two groups of 50 patients each. Patients in the study group were given ibuprofen-incorporated chitosan-based microspheres, which were packed into the third molar sockets after removal of impacted teeth. Patients in the control group were prescribed with ibuprofen 400mg tablets that were to be administered orally after the removal of impacted mandibular third molars. All patients were assessed for pain, swelling, and trismus on the second, fourth, and seventh postoperative days, and wound healing was assessed on the seventh postoperative day. Patients in the study group had significantly less pain and comparatively better mouth opening on the second, fourth, and seventh postoperative days, which showed clinically and statistically significant results of p<0.05, respectively, while the assessment of swelling for the study group did not show statistically significant results on any of the three postoperative days. Among 50 patients in the study group, two had wound gaping, and among 50 patients in the control group, four presented with wound gaping and three patients developed dry socket. Ibuprofen-incorporated chitosan-based microspheres (study group) had comparatively better analgesic and anti-inflammatory properties with drastic reduction of pain, swelling, trismus, and also had a reliable wound healing property when compared with the orally-administered ibuprofen (control group) after mandibular third molar surgery.


Assuntos
Quitosana , Preparações Farmacêuticas , Dente Impactado , Anti-Inflamatórios/uso terapêutico , Quitosana/uso terapêutico , Sistemas de Liberação de Medicamentos , Edema/tratamento farmacológico , Edema/etiologia , Edema/prevenção & controle , Humanos , Ibuprofeno/uso terapêutico , Mandíbula/cirurgia , Microesferas , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Extração Dentária , Dente Impactado/cirurgia , Trismo/etiologia , Trismo/prevenção & controle
17.
Support Care Cancer ; 29(4): 1825-1835, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32779007

RESUMO

OBJECTIVE: The purpose of this study was to estimate prevalence/severity of self-reported trismus, determine association with quality of life (QOL), and examine clinical risk factors in a large population of patients treated for oropharyngeal cancer. MATERIALS AND METHODS: A cross-sectional survivorship survey was conducted among patients who completed definitive treatment for oropharyngeal carcinoma, disease-free ≥ 1-year post-treatment (median survival, 7 years among 892 survivors). Associations between trismus and QOL were also analyzed using MDASI-HN, EQ-5D, and MDADI. Dietary and feeding tube status were also correlated to trismus status. RESULTS: Trismus was self-reported in 31%. Severity of trismus positively correlated (r = 0.29) with higher mean interference scores reflecting a moderate association with quality of life (p < 0.0001). There was a negative correlation for MDADI composite scores (r = - 0.33) indicating increased perceived dysphagia related to trismus severity (p < 0.0001). EQ-5D VAS scores were also negatively correlated with trismus severity (r = - 0.26, p < 0.0001). Larger T-stage (p ≤ 0.001), larger nodal stage (p = 0.03), tumor sub-site (p = 0.05), and concurrent chemoradiation (p = 0.01) associated with increased prevalence of trismus. Diet negatively correlated (r = - 0.27) with trismus severity (p = < 0.0001), and survivors with severe trismus were also more likely to be feeding tube-dependent. CONCLUSION: Severity of trismus appears to negatively impact quality of life and associate with various adverse functional outcomes in long-term oropharyngeal cancer survivorship. Trismus remains associated with advanced disease stages, tumor sub-site (tonsil), and addition of chemotherapy. Further investigation is merited for the dose-effect relationship to the muscles of mastication.


Assuntos
Neoplasias Orofaríngeas/complicações , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida/psicologia , Trismo/epidemiologia , Trismo/etiologia , Sobreviventes de Câncer , Estudos Transversais , Feminino , Humanos , Masculino , Neoplasias Orofaríngeas/mortalidade , Prevalência , Fatores de Risco , Autorrelato
18.
Med Oral Patol Oral Cir Bucal ; 26(2): e156-e163, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32701926

RESUMO

BACKGROUND: The objective of the present study was to compare the efficacy of different doses of methylprednisolone on postoperative sequelae and quality of life (QoL) following surgical removal of mandibular third molars (SRM3). MATERIAL AND METHODS: Fifty-two patients (16 men and 36 women, mean age 25.9 years, range: 18-39) with bilateral impacted mandibular third molars were randomly allocated into intraoperative muscular injection of either 20mg, 30mg, 40mg methylprednisolone or saline injection. Baseline measurements were obtained preoperatively and compared with assessment after one day, three days, seven days and one month. Pain and trismus were estimated by visual analog scale score and interincisal mouth opening, respectively. Subjective assessment of QoL included Oral Health Impact Profile (OHIP-14). Descriptive and generalized estimating equation analyses were made and expressed as mean values with a 95% confidence interval. RESULTS: Methylprednisolone revealed no significant differences in pain, trismus and QoL compared with placebo. Higher prevalence of postoperative pain and worsening in QoL were observed with increased age (P=0.00). Smoking and increased time of surgery decreased mouth opening in the early healing phase (P=0.00). CONCLUSIONS: The present study revealed no significant improvement of methylprednisolone on postoperative sequelae and QoL following SRM3 compared with placebo.


Assuntos
Qualidade de Vida , Dente Impactado , Adolescente , Adulto , Método Duplo-Cego , Edema , Feminino , Humanos , Masculino , Metilprednisolona/uso terapêutico , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Extração Dentária , Dente Impactado/cirurgia , Trismo/etiologia , Trismo/prevenção & controle , Adulto Jovem
19.
Clin Oral Investig ; 25(1): 345-353, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32691298

RESUMO

OBJECTIVES: The aim of this randomized observer-blinded split-mouth-study is to objectively assess the influence of a rubber drain on postoperative swelling using 3D face scans as measurement method and additionally evaluate pain, trismus and complications after the osteotomy of lower third molars. MATERIAL AND METHODS: Seventy-two patients with symmetrically impacted lower wisdom teeth were recruited. Before the operation, patients rated pain using the visual analogue scale, the interincisal distance was measured, and 3D face scans were taken with an optical scanner. Each patient underwent two procedures which were at least 30 days apart. On one side, a rubber drain was inserted randomly before closure, the contralateral control side was closed without drainage. On the third and tenth postoperative day, face scans to quantify the swelling, pain evaluation and trismus measurements were performed. Due to loss of follow-up, 32 patients were excluded which resulted in 40 out of 72 patients remaining in the study. RESULTS: There was no statistical difference in using a drain on swelling and trismus on the third and tenth day (p > 0.05). Pain was slightly worse on the third day on the treatment side, but the difference was not significant (p > 0.05). We observed no differences in the number of wound infections. CONCLUSIONS: The insertion of a rubber drain does not have any influence on swelling, pain or trismus and has no impact on the number of wound infections. CLINICAL RELEVANCE: The use of a rubber drain cannot be recommended as no reduction of postoperative discomfort was detected.


Assuntos
Drenagem/métodos , Dente Serotino , Dente Impactado , Edema/etiologia , Edema/prevenção & controle , Humanos , Mandíbula/cirurgia , Dente Serotino/diagnóstico por imagem , Dente Serotino/cirurgia , Boca , Dor Pós-Operatória/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Trismo/etiologia , Trismo/prevenção & controle
20.
Med Oral Patol Oral Cir Bucal ; 26(2): e136-e140, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33037801

RESUMO

BACKGROUND: This study aimed to conduct a randomized prospective study about the efficacy of etodolac and ibuprofen on trismus, pain and edema regarding gender of patients submitted to impacted lower third molar teeth extraction. MATERIAL AND METHODS: Thirty patients aging between 16 and 35 year-old were submitted to the exodontia of impacted lower third molars. During the postoperative period, patients received nine ibuprofen (600 mg) or etodolac (300 mg) pills via oral administration immediately after surgery and repeated doses every eight hours during three days. Patients were evaluated regarding pain, trismus and edema. RESULTS: Sixteen men and fourteen women participated of the study. No statistical difference was established regarding gender according to the evaluated parameters. However, etodolac use showed better results regarding pain, trismus and edema. CONCLUSIONS: Pain, edema and trismus after impacted third molars extraction were not influenced by gender.


Assuntos
Dente Serotino , Dente Impactado , Adolescente , Adulto , Edema/etiologia , Edema/prevenção & controle , Etodolac , Feminino , Humanos , Ibuprofeno/uso terapêutico , Masculino , Dente Serotino/cirurgia , Boca , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Trismo/etiologia , Trismo/prevenção & controle , Adulto Jovem
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