Factors influencing neck and shoulder function after oral oncology treatment: a five-year prospective cohort study in 113 patients.

BACKGROUND: The aim of this study was to identify factors influencing shoulder and/or neck function in patients up to five years after treatment. MATERIALS AND METHODS: Lateral flexion of the neck, ipsilateral forward flexion, and abduction of the shoulder were measured. Potential factors were entered into a linear mixed model analysis to create a multivariate model for describing the results. RESULTS: Predicted neck and shoulder function was negatively influenced by higher age before intervention. Contralateral flexion of the neck was lower for patients undergoing surgery and radiotherapy compared to surgery. Ipsilateral flexion of the neck is influenced by a higher age at baseline. Ipsilateral shoulder abduction is lower for female gender, bone graft/flap reconstruction, and more extensive neck dissection. Ipsilateral forward flexion of the shoulder is lower for bone graft/flap reconstruction and better for patients with a T2 tumor in comparison to T3 and T4 tumors, as predicted. CONCLUSION: By our five-year follow-up outcomes of this study, neck and/or shoulder impairments can be found for high-risk patients by physiotherapists.

Costs and clinical outcomes of implant placement during ablative surgery and postponed implant placement in curative oral oncology: a five-year retrospective cohort study.

OBJECTIVES: The aim of this study was to compare costs and clinical outcomes of two protocols for implant placement in edentulous oral cancer patients: implant placement during ablative surgery and postponed implant placement. MATERIAL AND METHODS: All edentulous patients who underwent curative tumor surgery between 2007 and 2009 at the Radboud university medical center (Radboudumc) and UMC Utrecht, both in the Netherlands, were included retrospectively. At the Radboudumc, 79 of 98 patients received implants during ablative surgery. At the UMC Utrecht, 18 of 95 patients received implants after a disease-free period of at least 6 months, because satisfying conventional dentures could not be made. Costs, implant details and clinical outcomes were recorded retrospectively up to 5 years after tumor surgery. RESULTS: Individual costs of implant placement were lower in the during-ablative-surgery protocol (€2235 vs. €4152), while implant failure and loading were comparable to the postponed-placement protocol. In the during-ablative-surgery protocol, more patients received implant-retained overdentures (62% vs. 17%) and more patients had functioning dentures (65% vs. 47%), which were placed at an earlier stage (291 vs. 389 days after surgery). Overall costs of the during-ablative-surgery protocol were higher, as more patients received implants and functioning implant-retained dentures, which were more expensive than conventional dentures. CONCLUSIONS: Placing implants during ablative surgery lowered the individual costs of implant placement and led to more patients with functioning dentures, while implant failure and loading were comparable to postponed placement.

Maximum mouth opening and trismus in 143 patients treated for oral cancer: a 1-year prospective study.

BACKGROUND: Patients with oral cancer can develop restricted mouth opening (trismus) because of the oncologic treatment. METHODS: Maximum mouth opening (MMO) was measured in 143 patients shortly before treatment and 0, 6, and 12 months posttreatment, and the results were analyzed using a linear mixed-effects model. RESULTS: In every patient, MMO decreased after treatment. The patients who underwent surgery, recovered partially by 6 and 12 months after treatment, whereas the patients who received both surgery and radiotherapy or primary radiotherapy did not recover. Tumor location, tumor size, and alcohol consumption had independent effects on MMO. Having trismus (MMO <35 mm) 1 year after treatment was associated most strongly with pretreatment MMO, receiving both surgery and radiotherapy, and maxillary or mandibular tumor involvement. CONCLUSION: Postoperative radiotherapy and maxillary or mandibular tumor involvement are the highest contributing risk factors to decreasing MMO and the subsequent development of trismus after oral cancer treatment.