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1.
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
2.
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
3.
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
4.
Am J Phys Med Rehabil ; 100(5): e62-e64, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732743

RESUMO

ABSTRACT: A 38-yr-old man presented to the emergency department with severe chest pain and was found to have a type A aortic dissection. Forty-eight hours after an emergency mechanical Bentall and ascending hemiarch replacement, the patient developed agitation prompting administration of high-dose haloperidol. He was found to have evidence of multiple acute infarcts on head computed tomography/computed tomography angiography and brain magnetic resonance imaging. Four days later, he began to complain of jaw pain and difficulty opening his mouth. After admission to inpatient rehabilitation, he was found to have strong activity in the masseters bilaterally at rest on electromyography, indicating a diagnosis of oromandibular dystonia. Starting in the intensive care unit, the patient reported jaw pain and dysfunction for 40 days before having a diagnosis of oromandibular dystonia. At this point, treatment with onabotulinumtoxinA injections and baclofen did not provide relief. Because of an extended delay in diagnosis, it is believed that the patient has developed joint contractures. Oromandibular dystonia is an important diagnosis to consider in patients who experience jaw pain or difficulty with mouth opening. Treatment of this condition can decrease pain and trauma to oral structures as well as improve ability to perform oral hygiene, eat, and communicate.


Assuntos
Diagnóstico Tardio , Distonia/diagnóstico , Doenças Maxilomandibulares/diagnóstico , Trismo/diagnóstico , Adulto , Aneurisma Dissecante/terapia , Toxinas Botulínicas Tipo A/uso terapêutico , Infarto Encefálico/terapia , Diagnóstico Diferencial , Distonia/terapia , Hospitalização , Humanos , Doenças Maxilomandibulares/terapia , Masculino , Trismo/terapia
5.
Support Care Cancer ; 29(7): 3793-3800, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32435968

RESUMO

PURPOSE: This study aims to examine effects of jaw exercise on trismus 3 years following completion of a post-radiotherapy jaw exercise intervention. METHODS: Prospective study including 50 patients with head-and-neck cancer receiving radiotherapy and/or chemotherapy, plus a matched control group. The intervention group underwent 10 weeks of jaw exercise training. Patients were followed pre-and postintervention and 3 years postintervention completion. Outcome measures were maximal interincisal opening (MIO), trismus-related symptoms, and health-related quality-of-life as measured by Gothenburg Trismus Questionnaire, EORTC QLQ-C30, and EORTC QLQ-H&N35. RESULTS: The intervention group had a statistically significantly higher mean MIO compared with the control group (40.1 mm and 33.9 mm, respectively, p < 0.001), reported less trismus-related problems and had an improved health-related quality-of-life when compared with the control group at the 3-year follow-up. These differences were all statistically significant. CONCLUSION: Jaw exercise therapy resulted in increased MIO, less trismus-related symptoms, and improved health-related quality-of-life. Jaw exercise therapy should be initiated early, in a structured manner and continued long-term.


Assuntos
Terapia por Exercício/métodos , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/terapia , Trismo/terapia , Adulto , Idoso , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
6.
Pan Afr Med J ; 36: 377, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33235654

RESUMO

Tetanus is a major public health problem in sub-Saharan Africa. Localised tetanus is rare, unlike generalized tetanus which has been sufficiently described in the literature. We report a case of localised tetanus with no obvious entry site managed in the Department of Infectious Diseases in Bamako. The study involved a retired nurse aged 59 years who had not undergone tetanus booster immunisation within the last 10 years, corresponding to the date of her last delivery. She was referred to our Hospital with dysphagia associated with inability to open the buccal cavity. Patient's history was characterized by long-term therapy associated with many specialized consultations without any improvement. The diagnosis of localised tetanus with no obvious entry site was retained after having excluded any other local disorder. Outcome was favorable ten days after adequate management. Underdiagnosed or unknown to health-care providers, localised tetanus may mimic other diseases delaying diagnosis and management. Targeted campaign to build awareness should be implemented in order to improve adherence with immunization schedules.


Assuntos
Tétano/diagnóstico , Tétano/terapia , Trismo/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Mali , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Tétano/complicações , Tétano/transmissão , Toxoide Tetânico/administração & dosagem , Trismo/etiologia , Trismo/patologia , Trismo/terapia , Vacinação
7.
JCO Oncol Pract ; 16(10): 643-653, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33049177

RESUMO

Restricted mouth opening or trismus is often encountered in patients with head and neck cancer. The restriction may be the presenting sign of malignancy, a sequela of tumor site or growth, an adverse effect of oncologic treatment, or a first sign of tumoral recurrence. In general, any insult to the temporomandibular joint, masticatory muscles, or their neural innervation may cause limitation in mouth opening. The etiologies leading to trismus are as follows: myospasm secondary to tumor infiltration; reflectory myospasm; radiation-induced myositis and myofibrosis; temporomandibular joint involvement with tumor; unfavorable postsurgical scarring; muscle and joint atrophy secondary to immobilization; pain; jaw fracture and hardware failure; and infection. Preventive measures should be implemented before, during, and after treatment. These measures include identification of high-risk patients, utilization of dose-sculpting radiation techniques whenever possible, performing reconstruction at the same time of resective surgery whenever feasible, and initiating mobilization exercises as early as possible. When trismus develops, treatments are often challenging and disappointing. These include physical therapy, mouth opening appliances, drug therapy, and release surgery. All medical specialties dealing with head and neck cancer should be familiar with the diagnosis and prevention of trismus and make an effort to ensure patients are referred to the appropriate care when needed. Trismus should not be considered a trivial sequela of head and neck cancer.


Assuntos
Neoplasias de Cabeça e Pescoço , Boca/patologia , Recidiva Local de Neoplasia , Trismo , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Músculos da Mastigação , Trismo/etiologia , Trismo/terapia
8.
BMC Oral Health ; 20(1): 41, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024498

RESUMO

BACKGROUND: This study aimed to evaluate the efficacy of ozonized water on pain, oedema and trismus after impacted third molar mandibular surgeries when compared to double distilled water. A randomized triple blind trial was conducted. METHODS: Patients with third molars class II-B of Pell-Gregory were included, and surgical extraction was performed. Irrigation was done with ozonized (group 1) or double distilled water (group 2). The type of irrigation and the side to be operated were randomized. Neither the patients nor the operator or evaluator were aware of the irrigation solution. Pain, oedema and trismus were evaluated at baseline, 24-h, 48-h, 72-h and 7-days after treatment. The data were evaluated by Friedman, Wilcoxon, Mann-Whitney tests, and size effect. RESULTS: It was included 8 men and 12 women, with a mean age of 20.9y.o. The initial pain mean was 7.94 (±12.81) (group 1) and 5.50 (±9.12) (group 2) (p > 0,05). There was a statistically significant reduction of pain, oedema and trismus in intragroup analysis (p < 0.05). There was no statistically significant difference (p > 0.05) when comparing the oedema and trismus between groups. The size effect ranged from small (0.23) to large (1.29). CONCLUSIONS: It was concluded that ozonized water was compatible as irrigation method, not inferior to double distilled water, and had satisfactory effects on management of pain, oedema and trismus after surgical removal of the third molar. TRIAL REGISTRATION: This clinical trial was registered in ClinicalTrials.gov NCT03501225 on April 18, 2018.


Assuntos
Edema/terapia , Dente Serotino/cirurgia , Ozônio/uso terapêutico , Dor Pós-Operatória/terapia , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Trismo/terapia , Água/farmacologia , Método Duplo-Cego , Edema/etiologia , Feminino , Humanos , Masculino , Dor Pós-Operatória/etiologia , Resultado do Tratamento , Trismo/etiologia
9.
J Craniofac Surg ; 31(2): 488-491, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31996539

RESUMO

Trismus is a frequent complication of healed Noma infection and is caused by soft tissue and muscle contraction. Free-flap surgery is recommended to replace the missing oral mucosa and soft tissue. However, significant complications can occur if this surgery is performed in places like Africa, where conditions are usually less than optimal. In 2007, the authors started to treat patients with trismus in Niamey, Niger by distracting the soft tissue and muscle constriction between the jaws with a bone distractor continuously for 1 month with the aim of achieving a mouth opening of 3 cm. The distraction was limited to 1 mm/d. performed under local anesthesia with some sedation. Minor complications such as infection in the pin holes were easily managed. In 2009, 2 patients with trismus after Noma with a follow-up of 2 years were reported. Till date, the authors have successfully performed trismus release in more than 69 patients in Niamey and Guinea Bissau. The present study analyses the results of distraction therapy in 40 patients with follow-ups until 60 months. At the end of distraction, the mean interincisal distance was 2.7 ±â€Š0.5 cm. Mouth opening 6 months after distraction had not reverted. However, 3 to 5 years after treatment, some signs of relapse were detected, with an average mouth opening of 1.5 ±â€Š1.9 cm. Physiotherapy was unfortunately not feasible. The presented results strongly support the efficacy of distraction therapy to correct trismus in Noma patients.


Assuntos
Noma/complicações , Trismo/terapia , Criança , Humanos , Mucosa Bucal , Modalidades de Fisioterapia , Trismo/etiologia
10.
Clin Genet ; 97(1): 209-221, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31497877

RESUMO

Crisponi/cold-induced sweating syndrome (CS/CISS) is an autosomal recessive disease characterized by hyperthermia, camptodactyly, feeding and respiratory difficulties often leading to sudden death in the neonatal period. The affected individuals who survived the first critical years of life, develop cold-induced sweating and scoliosis in early childhood. The disease is caused by variants in the CRLF1 or in the CLCF1 gene. Both proteins form a heterodimeric complex that acts on cells expressing the ciliary neurotrophic factor receptor (CNTFR). CS/CISS belongs to the family of "CNTFR-related disorders" showing a similar clinical phenotype. Recently, variants in other genes, including KLHL7, NALCN, MAGEL2 and SCN2A, previously linked to other diseases, have been associated with a CS/CISS-like phenotype. Therefore, retinitis pigmentosa and Bohring-Optiz syndrome-like (KLHL7), Congenital contractures of the limbs and face, hypotonia, and developmental delay syndrome (NALCN), Chitayat-Hall/Schaaf-Yang syndrome (MAGEL2), and early infantile epileptic encephalopathy-11 syndrome (SCN2A) all share an overlapping phenotype with CS/CISS, especially in the neonatal period. This review aims to summarize the existing literature on CS/CISS, focusing on the current state of differential diagnosis, pathogenesis and treatment concepts in order to achieve an accurate and rapid diagnosis. This will improve patient management and enable specific treatments for the affected individuals.


Assuntos
Craniossinostoses/diagnóstico , Citocinas/genética , Deformidades Congênitas da Mão/diagnóstico , Hiperidrose/diagnóstico , Deficiência Intelectual/diagnóstico , Receptores de Citocinas/genética , Trismo/congênito , Subunidade alfa do Receptor do Fator Neutrófico Ciliar/genética , Craniossinostoses/genética , Craniossinostoses/patologia , Morte Súbita/patologia , Diagnóstico Diferencial , Facies , Deformidades Congênitas da Mão/patologia , Deformidades Congênitas da Mão/terapia , Humanos , Hiperidrose/patologia , Hiperidrose/terapia , Deficiência Intelectual/genética , Deficiência Intelectual/patologia , Retinite Pigmentosa/diagnóstico , Retinite Pigmentosa/genética , Retinite Pigmentosa/patologia , Escoliose/diagnóstico , Trismo/diagnóstico , Trismo/patologia , Trismo/terapia
11.
Support Care Cancer ; 28(1): 9-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31701267

RESUMO

PURPOSE: To compare the effects of two stretching devices, the TheraBite® Jaw Motion Rehabilitation System™ and the Dynasplint Trismus System®, on maximal mouth opening in head and neck cancer patients. METHODS: Patients were randomly assigned to one of two exercise groups: the TheraBite® Jaw Motion Rehabilitation System™ group or the Dynasplint Trismus System® group. Patients performed stretching exercises for 3 months. During the three study visits, maximal mouth opening was measured and the patients completed questionnaires on mandibular function and quality of life. RESULTS: In our study population (n = 27), five patients did not start the exercise protocol, eight patients discontinued exercises, and two patients were lost to follow-up. No significant differences regarding the change in mouth opening between the two devices were found. Patients had an increase in MMO of 3.0 mm (IQR - 2.0; 4.0) using the TheraBite® Jaw Motion Rehabilitation System™ and 1.5 mm (IQR 1.0; 3.0) using the Dynasplint Trismus System®. Exercising with either stretching device was challenging for the patients due to the intensive exercise protocol, pain during the exercises, fitting problems with the stretching device, and overall deterioration of their medical condition. CONCLUSIONS: The effects of the two stretching devices did not differ significantly in our study population. The factors described, influencing the progression of stretching exercises, need to be taken into account when prescribing a similar stretching regimen for trismus in head and neck cancer patients. TRIAL REGISTRATION: NTR - Dutch Trial Register number: 5589.


Assuntos
Equipamentos e Provisões , Terapia por Exercício/instrumentação , Neoplasias de Cabeça e Pescoço/terapia , Exercícios de Alongamento Muscular/instrumentação , Trismo/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Exercício Físico/fisiologia , Terapia por Exercício/métodos , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Exercícios de Alongamento Muscular/métodos , Qualidade de Vida , Amplitude de Movimento Articular/fisiologia , Inquéritos e Questionários , Trismo/etiologia , Adulto Jovem
13.
Eur Ann Otorhinolaryngol Head Neck Dis ; 136(4): 251-255, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30928200

RESUMO

AIMS: To evaluate the effect of pregabalin on radiotherapy-induced trismus in patients with nasopharyngeal carcinoma, a hospital-based, clinical retrospective cohort study was conducted. MATERIALS AND METHODS: Data were collected on patients diagnosed with radiotherapy-induced trismus from March 2014 and March 2016 in the department of neurology in our hospital. Patients in the treatment group were administrated pregabalin for 8 weeks combined with rehabilitation, while the control group only received rehabilitation. The clinical therapeutic effects were observed and evaluated by mandibular motion, severity of trismus measured by late effects of normal tissues/subjective and objective medical analysis (LENT/SOMA) scales, and quality of life (QOL) assessed using the World Health Organization QOL instrument (WHOQOL-BREF) at baseline, week 4 and week 8 during treatment in these two groups, respectively. RESULTS: In the treatment group, the number of patients with improvement on maximal vertical dimension (MVD) was significantly more than controls at week 4 and week 8 (P=0.013, P=0.004, respectively). Moreover, at week 4 and week 8, the severity of trismus was both significantly improved on LENT/SOMA grade in treatment group (P=0.047, P=0.032, respectively). And at week 8, the physical health and the whole life domain of the WHOQOL-BREF score were significantly increased (P=0.037, P=0.034, respectively). In the treatment group, 11 patients (36.7%) presented dizziness, and 7 patients (23.3%) presented somnolence. CONCLUSIONS: Administration of pregabalin, in adjunct to rehabilitation, might provide a better outcome in patients with radiotherapy-induced trismus.


Assuntos
Anticonvulsivantes/uso terapêutico , Neoplasias Nasofaríngeas/radioterapia , Pregabalina/uso terapêutico , Trismo/etiologia , Trismo/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/radioterapia , Modalidades de Fisioterapia , Radioterapia/efeitos adversos , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
14.
Ann Otol Rhinol Laryngol ; 128(6): 541-547, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30767566

RESUMO

OBJECTIVES: Platelet-rich plasma (PRP) was administered into the temporomandibular joint (TMJ) space, which had been exposed to radiotherapy (RT), in an attempt to prevent and/or treat the late-term complications associated with RT when used for the treatment of head and neck cancers (nasopharyngeal cancer in particular) on the musculoskeletal system. METHODS: A total of 13 adult male New Zealand ( Oryctolagus cuniculus) rabbits were used in the study. The animals were classified into 3 groups: 6 in the RT group, 6 in the RT+PRP group, and 1 in the control group (exposed to neither). The TMJ space of each rabbit was exposed to 2240 cGy external RT in total, and PRP was administered into the TMJ space 1 month later. The joints were surgically removed 1 month later and examined histopathologically. RESULTS: In the group given RT+PRP, the level of inflammation, amount of muscle fibrosis, vascular wall fibrosis, synovial membrane and condyle cartilage thickness, temporal extrabone fibrous cell layer count, and intramuscular changes were similar to those recorded in the control group, although the positive effects of PRP were not found to be statistically significant. CONCLUSIONS: The findings of the present study demonstrate that injections of PRP may increase joint inflammation and therefore enhance blood supply, resulting in the onset of regeneration. These favorable effects of PRP may be helpful in the fight against late-term musculoskeletal complications of RT and may minimize such side effects as sore jaw, malnutrition, and weight loss.


Assuntos
Neoplasias Nasofaríngeas/radioterapia , Plasma Rico em Plaquetas , Lesões por Radiação/terapia , Transtornos da Articulação Temporomandibular/terapia , Articulação Temporomandibular/efeitos da radiação , Animais , Cartilagem Articular/patologia , Cartilagem Articular/efeitos da radiação , Modelos Animais de Doenças , Fibrose , Inflamação/patologia , Masculino , Coelhos , Radioterapia/efeitos adversos , Membrana Sinovial/patologia , Membrana Sinovial/efeitos da radiação , Articulação Temporomandibular/irrigação sanguínea , Articulação Temporomandibular/patologia , Trismo/terapia
15.
J Prosthet Dent ; 121(2): 353-357, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30392749

RESUMO

For patients with head and neck cancer requiring a maxillectomy, obturator prostheses help with quality of life. These patients routinely require adjuvant oncologic treatments with significant adverse effects. Treatment sequelae can leave patients with difficulty speaking and swallowing, reduced salivary function, reduction in maximal incisal opening, and at risk of osteoradionecrosis. A 55-year-old African-American woman presented with significant trismus and reduction in maximal incisal opening after treatment for squamous cell carcinoma of the left maxillary sinus. She had received a left total maxillectomy with adjuvant chemotherapy and radiation treatments. With her reduced opening, she was no longer able to insert her interim obturator prosthesis, which caused difficulty speaking and nasal regurgitation. A cone beam computed tomography scan was made of the patient's maxillectomy defect. From the Digital Imaging and Communications in Medicine file, a definitive cast was 3-dimensionally printed to fabricate a flexible silicone obturator prosthesis. This treatment has allowed the patient to return to a functional quality of life and could help other patients in similar situations.


Assuntos
Carcinoma de Células Escamosas/terapia , Obturadores Palatinos , Neoplasias dos Seios Paranasais/terapia , Impressão Tridimensional , Silicones/química , Terapia Combinada , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Trismo/terapia
16.
Int. arch. otorhinolaryngol. (Impr.) ; 23(2): 221-228, 2019. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-1015570

RESUMO

Introduction: Cold therapy (cryotherapy) is a common procedure recommended by dental surgeons after surgical removal of thirdmolars, which is an invasive intervention that often deals with an expressive inflammatory response. Objective: To investigate whether cryotherapy interferes with clinical outcomes such as pain, edema, and trismus in the postoperative period of mandibular third molar surgeries. Data Synthesis: An electronic search was conducted in the OVID, PubMed, VHL, Science Direct, Cochrane Library, and Web of Science databases, through March 2018. The eligibility criteria included clinical trials that evaluated the effect of cryotherapy in at least one of the following variables: pain, swelling, and trismus. Two independent reviewers assessed the studies. The methodological quality of each article was analyzed. The search strategy resulted in 1,088 articles. Following the selection process, 11 studies were included in the systematic review and 4 of them in the meta-analysis. High risk of bias was found in most of the studies according to the Cochrane Handbook assessment. Patients receiving cryotherapy had less edema than patients in the control group at second day follow-up (mean difference [MD]: -0.94; 95%CI [-1.49; -0.39]). There were no statistically significant results when comparing trismus between experimental and control group (MD: 0.43; 95%CI [-0.34;1.20]). There were insufficient available data to support influences in postoperative pain. Conclusions: Cryotherapy applied on thefirstday aftermandibular third molar removal can manage edema in the patients.Well-designed randomized clinical trials to test the efficacy of cryotherapy after surgical removal of third molars are needed to justify its indication (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Extração Dentária/efeitos adversos , Crioterapia , Inflamação/terapia , Cuidados Pós-Operatórios , Trismo/terapia , Resultado do Tratamento , Procedimentos Cirúrgicos Bucais/reabilitação , Edema/terapia , Manejo da Dor , Dente Molar/cirurgia
17.
J Contemp Dent Pract ; 19(9): 1147-1151, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30287719

RESUMO

AIM: The present study was conducted to assess the effect of irrigation with three different irrigants, namely normal saline, chlorhexidine, and povidone iodine on pain, alveolar osteitis, swelling, trismus, infection, and food impaction during surgical removal of impacted mandibular third molar. MATERIALS AND METHODS: Forty-eight patients, including 26 males and 22 females, fulfilling criteria for inclusion in this study were divided into three groups: group I where irrigant used was normal saline, group II as chlorhexidine, and group III as povidone iodine group. RESULTS: The pain was significantly more in groups I and III in 24 hours and 7th day as well. Alveolar osteitis was noted in groups III and I, nil in group II. The facial swelling measured in millimeters on 24 hours and on 7th day was significantly higher in 24 hours in groups I and III than in group II. Trismus was significantly more in group I and group III than in group II (with p < 0.01) on 7th day. CONCLUSION: It is concluded that chlorhexidine is effective in reducing pain, alveolar osteitis, swelling, and trismus when used as an irrigant following surgical removal of impacted third molar. CLINICAL SIGNIFICANCE: Chlorhexidine as irrigating solution helps in reducing the postoperative consequences after third molar surgery. Further studies are required using large sample size.


Assuntos
Clorexidina/administração & dosagem , Cuidados Intraoperatórios , Dente Serotino/cirurgia , Povidona-Iodo/administração & dosagem , Solução Salina/administração & dosagem , Irrigação Terapêutica/métodos , Extração Dentária , Dente Impactado/cirurgia , Adulto , Estudos Transversais , Alvéolo Seco/terapia , Edema/terapia , Feminino , Humanos , Masculino , Dor Pós-Operatória/terapia , Complicações Pós-Operatórias/terapia , Soluções , Resultado do Tratamento , Trismo/terapia , Adulto Jovem
18.
Niger J Clin Pract ; 21(9): 1107-1113, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30156193

RESUMO

Purpose: This study aimed to evaluate the effect of a low-level laser therapy (LLLT) on pain, trismus, and swelling of patients whose impacted 3rd molar tooth was extracted compared to placebo or "sham" treatment and measure volumetrically the edema with a three-dimensional (3D) surface imaging device (3dMD face system). Materials and Methods: Forty-five patients over 17 years of age were included in the study. Patients were randomized to three groups; Group 1, the control group, received only routine management (ice application) (n = 15); Group 2, received single-dose LLLT immediately after surgery (n = 15); and Group 3, placebo group, received sham therapy immediately after surgery (n = 15). In this study, a gallium-aluminum-arsenide diode laser device was used. The laser was applied extraorally (0.3 W, 40 s, 4 J/cm2). The trismus, pain, and facial swelling were evaluated. A 3D surface imaging device (3dMD Photogrammetric System) was used to evaluate the volumetric changes of the swelling. The 3D morphology of the facial swelling was recorded using this imaging device immediately before surgery, the second day after surgery, and the 7th day after surgery. IBM SPSS statistics 22.0 program was used in the statistical assessment and P < 0.05 was considered statistically significant. Results: There was no statistically significant difference in the edema and trismus between the groups. The pain level in Group 2 was significantly lower than that in Group 3 at all-time points. Furthermore, the pain level in Group 2 was significantly lower than that in Group 1 on day 7. Conclusions: LLLT reduced the intensity of pain following third molar surgery by single dose. The results of this study revealed that LLLT reduced facial swelling, but no significant differences were found among the three groups. In addition, a 3D craniomaxillofacial imaging method provided insight into volume changes after 3rd molar surgery and the evaluation of facial swelling in an objective way.


Assuntos
Edema/terapia , Imageamento Tridimensional , Terapia com Luz de Baixa Intensidade/métodos , Dente Serotino/cirurgia , Dor Pós-Operatória/terapia , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Trismo/prevenção & controle , Adulto , Método Duplo-Cego , Edema/etiologia , Face , Feminino , Humanos , Lasers Semicondutores/uso terapêutico , Masculino , Dente Serotino/diagnóstico por imagem , Manejo da Dor , Dor Pós-Operatória/etiologia , Projetos Piloto , Estudos Prospectivos , Extração Dentária/métodos , Dente Impactado/diagnóstico por imagem , Resultado do Tratamento , Trismo/terapia
19.
BMJ Open ; 8(3): e021938, 2018 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-29602860

RESUMO

INTRODUCTION: Patients can develop trismus from their head and neck cancer or as a result of treatment. Trismus affects the jaw muscles and makes mouth opening difficult. To potentially combat trismus, patients could undertake proactive jaw stretching exercises prior to, during and after radiotherapy, although currently these are not the standard of care. METHODS AND ANALYSIS: This is a randomised, open-label, controlled, two-centre feasibility study, to assess the objective and subjective effectiveness and cost-effectiveness of therabite use compared with wooden spatula in ameliorating trismus in patients treated for stage 3 and 4 oral and oropharyngeal cancer, managed either by primary surgery followed by (chemo)radiotherapy or primary (chemo)radiotherapy. The principal objective assessment is measurement of maximum jaw opening. Assessments in all cases will be performed preradiotherapy and again at 3 and 6 months postintervention.Secondary aims of the study will be (1) to assess whether therabite or the wooden spatula intervention improves patients' quality of life, (2) reduce the level of post-treatment clinical management/healthcare use and (3) a nested qualitative study will explore the experience of the patient taking part in the intervention; data will be transcribed verbatim and analysis will be based on content analysis methods using the interview questions as the framework for examination. ETHICS AND DISSEMINATION: North West Greater Manchester granted ethical approval (REC Reference 11/NW/0744). Good Clinical Practice and the Declaration of Helsinki have been adhered to. The results will be presented internationally and submitted to a peer-reviewed journal. Head and neck cancer charities and information websites will also be approached. TRIAL REGISTRATION NUMBER: NCT01733797.


Assuntos
Neoplasias de Cabeça e Pescoço , Protetores Bucais , Trismo , Adulto , Quimiorradioterapia , Desenho de Equipamento , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Projetos Piloto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Trismo/etiologia , Trismo/terapia
20.
Br J Oral Maxillofac Surg ; 56(4): 283-291, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29526341

RESUMO

Our aim was to compare the efficacy of the Therabite® jaw motion rehabilitation system (Atos Medical) with that of wooden spatulas to relieve and prevent trismus in patients who have had radiotherapy for stage three and four oral and oropharyngeal cancer. Secondary aims were to assess the feasibility and the impact of exercise on health-related quality of life (QoL), and the use of health services after treatment. We designed a randomised, open-label, controlled, three-centre feasibility study to compare the effectiveness and cost of the Therabite® and wooden spatulas. We studied compliance with exercises and health-related QoL, assessed cost using three health economics measures, and conducted semistructured interviews with patients. Patients were randomised into two groups: the Therabite® group (n=37) and the wooden spatula group (n=34). All patients had some sense of jaw tightening before the study started. Mean mouth opening after six months increased in both groups, but the difference between the groups was not significant (p=0.39). Completion rates for the three economic measures were good. There was no significant difference between the two groups in frequency of contact with care services or in QoL. Exercises during and after radiotherapy can ameliorate trismus in patients with stage three and four oral and oropharygeal cancers, but differences between groups in efficacy, compliance, QoL, or use of hospital or community health services, were not significant.


Assuntos
Neoplasias de Cabeça e Pescoço/complicações , Trismo/terapia , Quimiorradioterapia/efeitos adversos , Análise Custo-Benefício , Terapia por Exercício , Estudos de Viabilidade , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Entrevistas como Assunto , Neoplasias Bucais/complicações , Neoplasias Bucais/terapia , Protetores Bucais/economia , Neoplasias Orofaríngeas/complicações , Neoplasias Orofaríngeas/terapia , Qualidade de Vida , Trismo/economia , Trismo/etiologia , Trismo/prevenção & controle
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