Coblation cryptolysis method in treatment of tonsil caseum-induced halitosis.

PURPOSE: Halitosis, is a social problem affecting many patients seeking help from clinicians. Tonsil stones can cause halitosis and especially occur in crypts of palatine tonsils. Coblation cryptolysis is an alternative method for tonsil caseum treatment. The coblation technology includes passing a radiofrequency bipolar electrical current through a medium of normal saline which results in the production of a plasma field of sodium ions. In this study, our aim was to investigate the effectiveness of coblator cryptolysis treatment method in chronic caseous tonsillitis-induced halitosis. METHODS: We included in our study 28 patients who underwent coblator cryptolysis surgery for halitosis due to chronic caseous tonsillitis. The efficacy of treatment and the presence of caseoma were evaluated with the Finkelstein test, organoleptic test and VAS before the procedure and at the 6th month control after the treatment was completed. RESULTS: At the 6th month follow-up after the procedure (a single coblation cryptolysis) we found that 23 of the patients (82.1%) had no caseum. There was a statistically significant change in Finkelstein measurements before and after the procedure (p < 0.001). Organoleptic measurements demonstrated that 21 patients had no halitosis postoperatively and the mean organoleptic test score was calculated as 0.39 ± 0.79 after the procedure. The recovery was statistically significant (p < 0.001). The mean VAS score before coblation cryptolysis was 8.0 ± 1.33 (range 5-10). On the other hand 6 months after a single coblation cryptolysis session, the mean VAS score was 1.25 ± 1.78 (range: 0-6). This difference was statistically significant (p < 0.001). CONCLUSIONS: Our results suggest that coblation crptolysis is an effective, safe, minimally invasive and practical alternative method in treatment of halitosis due to tonsil caseums. We did not observe any complication after the procedure.

Laser tongue debridement for oral malodor-A novel approach to halitosis.

STUDY OBJECTIVE: Malodor is a multifactorial condition with oral pathology representing the main culprit and the tongue being the first to second contributor to the malodor. Bacterial load can represent a quantifiable measure regardless of the original pathology. We hypothesize that reduction in malodor can be represented by tongue changes both in appearance, bacterial and biofilm load reduction (measured by CFU and volatile gases measurement), organoleptic measurement and subjective improvement. METHODS: A randomized controlled prospective study under IRB approval. Diagnostic criteria for enrollment and follow up were organoleptic test by 2 judges, Halimeter reading, tongue colors changes HALT questionnaire and direct aerobic and anaerobic tongue cultures measured by CFU. Patients were treated with laser tongue debridement (LTD) with an Er,Cr:YSGG solid state laser has been shown to be effective in biofilm reduction. RESULTS: 54 patients recruited with 35 available for follow up. Improvement was observed on all objective and QOL subjective parameters. Treatment was tolerated well with minimal discomfort. CONCLUSIONS: The tongue is proven to be a major contributor to oral malodor and must be addressed in treatment protocol. LTD significantly reduces malodor by subjective and objective criteria. While impossible to determine whether the tongue serves as a bacterial reservoir or is the origin for oral bacteria it is clear that LTD improves oral hygiene and reduces malodor. LTD is safe and easy to perform. We encourage LTD to be a crucial part of any oral malodor treatment protocol. TRIAL REGISTRATION: clinical trials, NCT04120948. Registered 25 September 2019 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00098SX&selectaction=Edit&uid=U0000W0Y&ts=51&cx=-elnx7e.

Effectiveness of radiofrequency cryptolysis for the treatment of halitosis due to caseums.

OBJECTIVE: To evaluate the effectiveness of radiofrequency (RF) cryptolysis for caseum-induced halitosis. STUDY DESIGN: Clinical retrospective study. SETTING: Otorhinolaryngology Head and Neck Surgery Department of Konya Training and Research Hospital in Turkey. SUBJECTS AND METHODS: Thirty-four patients with caseum-induced halitosis were included. Eight were male (23.5%) and 26 were female (76.5%). Their mean age was 28.29 ± 9.3 (range: 17-48) years. The mean duration of complaint of halitosis before RF cryptolysis was 53.41 ± 42.6 months (range: 6-182 months). The Finkelstein test, organoleptic measurements, and visual analog scale (VAS) were performed before and 12 months after RF cryptolysis. RESULTS: Before RF cryptolysis, all patients had a positive Finkelstein's test result, organoleptic measurements revealed that three (8.82%) had serious halitosis, 24 (70.58%) had average halitosis, and seven (20.58%) had mild halitosis, and the mean VAS score was 6.82 ± 1.45. The follow-up period after RF cryptolysis was 12 months. After the single RF cryptolysis session, 26 patients (76.47%) were negative for Finkelstein's test, organoleptic assessments revealed that 26 (76.47%), six (17.64%), and two (5.88%) showed complete, partial, and no recovery, respectively, (p<0.001), and the mean VAS score was significantly better at 1.88 ± 2.5 (p<0.001). Thirty-two patients (94.1%) exhibited a decrease in VAS score. CONCLUSION: RF cryptolysis is a cost-effective, safe, and easily applicable modality for the treatment of halitosis due to caseums in the crypts of the palatine tonsils.

[Spontaneous exposition of a midline palatal torus]. / Exposición espontánea de un torus palatino de la línea media.

INTRODUCTION: Palatal torus, or torus palatinus, is a benign bone alteration that may cause some discomfort during phonation or swallowing. When its growth or persistent exposition produces unpleasant symptoms, it must be surgically removed. CASE PRESENTATION: We treated an 82-year-old female patient who consulted for a painful ulcerous lesion she had had for a year and which produced halitosis and discomfort when swallowing. During the oral cavity physical exam we observed a hard protuberance on the midline. It showed a perforation and ulceration of the lateral posterior palatal mucosa on the left side. We considered the following diagnosis: palatal torus, osteoma, pyogenic granuloma, or a soft-tissue neoplasia. We decided to surgically remove it and to perform a histopathological examination. Clinical evolution was satisfactory with complete resolution one month after surgery. The histopathological examination showed hyperostosis along with chronic inflammation of the soft tissues and a simple hyperplasia of the mucosa, which in turn indicated a palatal torus. DISCUSSION: We report an unusual case of spontaneous exposition of a palatal torus which took up almost all of the hard palate area. Its resection is described and we inform the histopathological findings. In the literature review, we did not find a previous report of a spontaneous exposition of a palatal torus.

Exposición espontánea de un torus palatino de la línea media / Spontaneous exposition of a midline palatal torus

Introducción. El torus , o rodete, palatino es una alteración ósea benigna que puede generar molestias en la fonación y en la deglución. Cuando su crecimiento o exposición persistente producen síntomas molestos, debe ser resecado quirúrgicamente. Presentación del caso. Se trata de una paciente de 82 años de edad, que consultó por una lesión ulcerativa de un año de evolución, que producía dolor, halitosis y molestia a la deglución. En el examen físico de la cavidad oral, se observó una prominencia de consistencia dura en la línea media, con perforación y ulceración de la mucosa palatina en su porción lateral posterior izquierda. Se consideraron los diagnósticos de torus palatino, osteoma, granuloma piógeno y neoplasia de tejidos blandos. Se decidió resecarla quirúrgicamente y hacer el estudio histopatológico. La evolución clínica fue satisfactoria, con resolución completa un mes después de la cirugía. En el estudio de histopatología se observó hiperostosis ósea con inflamación crónica de los tejidos blandos e hiperplasia simple de la mucosa, que corresponden a un torus palatino. Discusión. Se reporta un inusual caso de exposición espontánea de un torus palatino que ocupaba casi toda la bóveda palatina, se describe su resección quirúrgica y se informan los hallazgos de histopatología. En la revisión bibliográfica realizada, no se encontró un reporte previo de exposición espontánea de torus palatino.

Introduction: Palatal torus, or torus palatinus, is a benign bone alteration that may cause some discomfort during phonation or swallowing. When its growth or persistent exposition produces unpleasant symptoms, it must be surgically removed. Case presentation: We treated an 82-year-old female patient who consulted for a painful ulcerous lesion she had had for a year and which produced halitosis and discomfort when swallowing. During the oral cavity physical exam we observed a hard protuberance on the midline. It showed a perforation and ulceration of the lateral posterior palatal mucosa on the left side. We considered the following diagnosis: palatal torus, osteoma, pyogenic granuloma, or a soft-tissue neoplasia. We decided to surgically remove it and to perform a histopathological examination. Clinical evolution was satisfactory with complete resolution one month after surgery. The histopathological examination showed hyperostosis along with chronic inflammation of the soft tissues and a simple hyperplasia of the mucosa, which in turn indicated a palatal torus. Discussion: We report an unusual case of spontaneous exposition of a palatal torus which took up almost all of the hard palate area. Its resection is described and we inform the histopathological findings. In the literature review, we did not find a previous report of a spontaneous exposition of a palatal torus.

Temperature-controlled radiofrequency tonsil ablation for the treatment of halitosis.

The objective of the study was to evaluate the efficacy and safety of temperature-controlled radiofrequency (RF) tonsil ablation in the treatment of halitosis caused by chronic tonsillitis with caseum. The study method was retrospective. The medical records of 58 patients undergoing temperature-controlled RF tonsil ablation due to chronic tonsillitis with caseum between November 1, 2005 and November 30, 2008 were reviewed. Forty-nine (84.4%) of 58 patients reported complete disappearance of bad breath after the first treatment; five patients (8.6%) reported as having insufficient improvement and four (6.9%) patients had no change. Two patients from "insufficient group" and all four patients from "no change" group agreed to a repeat treatment. After the second session, four (6.9%) patients reported complete disappearance of halitosis with the disappearance of caseum formation. But two patients still suffered from halitosis. One of these patients underwent tonsillectomy, other patient is under our follow-up. Overall, complete elimination of halitosis was accomplished with one session in 49 (84.4%) patients, two sessions in four (6.9%) patients, making a total of 53 (91.3%) patients. Postoperative morbidities included one transient mild bleeding, one secondary bleeding and one mild edema. Temperature-controlled RF tonsil ablation is an effective method for treating halitosis which derived from chronic tonsillitis with caseum. This well-tolerated technique avoids the post-procedure morbidities and discomfort of more invasive surgical modalities currently used.

Halitosis en el niño y el adolescente / Halitosis in children and adolescents

La halitosis es el olor desagradable procedente de la boca, la nariz o las vías respiratorias. No suele ser un motivo de consulta directa en pediatría, pero con frecuencia es mencionada por la familia del paciente. En muchas ocasiones, los profesionales sanitarios no están suficientemente sensibilizados ante este tipo de molestia, y además la información sobre el tema es escasa. Sin embargo, este síntoma debe tenerse en cuenta, ya que puede ser la manifestación de diversos trastornos médico-odontológicos, además de la implicación social, económica y psicológica que puede tener, sobre todo en el adolescente. En este artículo se pretende revisar la bibliografía referente a la etiología, la fisiopatología, el diagnóstico y las diferentes opciones terapéuticas, incluidas las más novedosas, para facilitar su manejo en la práctica diaria pediátrica. Es necesaria la educación del paciente afectado y de sus familiares, de modo que sean ellos mismos quienes adopten unos hábitos higiénicos saludables y efectivos (AU)

Halitosis is an unpleasant odour emanating from mouth, nose or airway. This is not a usual reason for a direct consultation in pediatrics but is frequently mentioned by the patient´s family. On many occasions, health professionals are not concerned about this type of discomfort. Information about this problem is scarce. This symptom should be taken into account as it can be the manifestation of several medical and odontological disorders and for the social, economical and psychological implications, mostly in adolescents. The intention of this work is to revise bibliography about etiology, physiopathology, diagnosis and different therapeutic options of halitosis including the newest ones, in order to facilitate the daily practice at a pediatric level. The education of the affected patient is necessary in order to acquire healthy and effective hygienic habits to cope with the halitosis (AU)

Tonsillectomy for the treatment of halitosis.

BACKGROUND: Halitosis, or oral malodor, is a term used to describe noticeably unpleasant odors exhaled in breathing whether the smell is from an oral source or not. Oral causes have been proposed to be responsible for the majority of halitosis complaints. The study aims to investigate the tonsils as an origin of halitosis and to assess the efficacy of tonsillectomy for the treatment of oral bad breath caused by chronic tonsillitis. METHODS: After excluding dental, periodontal, sinonasal, oral, pulmonary, and gastroenterological diseases as the origin of halitosis, forty-four patients with halitosis caused by chronic tonsillitis which proved by positive Finkelstein's tonsil smelling test (pressing the tonsils and smelling the squeezed discharge), were included in the study. All patients were treated by tonsillectomy. Subjective and objective postoperative assessment was based on self-and-family report and clinical assessment. Patients were reviewed after 4 and 8 weeks postoperatively. RESULTS: Complete improvement of halitosis occurred in 31 patients (70.4%) after 4 weeks, this value increased to 35 patients (79.5%) in the second review after 8 weeks. CONCLUSIONS: Tonsillectomy is significantly effective procedure for the treatment of halitosis caused by chronic tonsillitis.

[Diagnostic image (367). A man with foetor ex ore]. / Diagnose in beeld (367). Een man met foetor ex ore.

A 54-year-old man presented with foetor ex ore due to a rhinolith in the left nasal cavity.

CO2 laser cryptolysis by coagulation for the treatment of halitosis.

OBJECTIVE: The aim of this study was to evaluate the impact of CO(2) laser cryptolysis by coagulation (LCC) treatment in the volatile sulphur compounds (VSC) halitometry in patients with chronic caseous tonsillitis (CCT). BACKGROUND DATA: Caseum retention and halitosis characterize CCT. Failure of clinical treatment indicated tonsillectomy. Recently, a conservative new treatment, CO(2 )LCC, has been introduced. It is painless and opens the crypt ostium, thus avoiding caseum retention. Halitometry is an objective new method for halitosis diagnosis. It measures VSC in parts per billion (ppb) in breathed air. METHODS: Thirty-eight patients with CCT and complaints of halitosis were selected, underwent physical examination and halitometry measurements, and then received four sessions of LCC. The laser technique consisted of 6-W applications, in scanned and unfocused mode, around crypts, following the shape of their openings (fluence 54.5 joules/cm(2)) and, afterwards, over the entire tonsillar surface (fluence 18 joules/cm(2)). Halitometries were done before each LCC session. RESULTS: LCC was well tolerated by all patients, and all patients showed improvement in halitosis after LCC treatment. Eight patients (21%) had abnormal halitometry (>150 ppb) before treatment, but after LCC sessions their halitometry values became normal. These patients had caseum at examination. VSC measurement was reduced by 30.1%, and caseum retention was significantly decreased in this group. CONCLUSION: Abnormal halitometry in this population is related to the presence of caseum. LCC is safe, well tolerated, and improves complaints of halitosis in patients with CCT. Improvement was related to a decrease in caseum retention. Patients with abnormal halitometry had VSC halitometry improvement of approximately 30%.

Laser cryptolysis for the treatment of halitosis.

OBJECTIVE: To evaluate the tonsils as a source of halitosis and to assess the efficacy of laser CO(2) cryptolysis for the treatment of oral bad breath caused by chronic fetid tonsillitis. METHODS: Fifty-three patients with halitosis originating from chronic fetid tonsillitis, who completed laser cryptolysis were enrolled in the study. The origin of halitosis was demonstrated by Finkelstein's tonsil smelling test, which included massaging the tonsils and smelling the squeezed discharge. All patients were treated by laser cryptolysis, an office procedure done under topical anesthesia. Subjective and objective postoperative assessment was based on self-and-family report and clinical assessment. Patients were reexamined 4 to 6 weeks post-treatment, and when the need for further laser treatment was determined. RESULTS: Complete elimination of halitosis required one session in 28 patients (52.8%), 2 sessions in 18 patients (34%), and 3 sessions in 5 patients (9.4%). Follow-up period ranged from 3 to 36 months (mean, 20.8 +/- 8.5 months). No adverse effects or complications were encountered. CONCLUSIONS: After excluding dental or periodontal, sinonasal, oral, pulmonary, or gastroenterological diseases as the origin of halitosis, chronic fetid tonsillitis remains a common cause of halitosis. Patients suffering from halitosis should be treated relying on their examination including Finkelstein's tonsil smelling test. Laser CO(2) cryptolysis is an effective, safe, and well-tolerated procedure for the treatment of halitosis.