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1.
Microsurgery ; 44(6): e31235, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39268866

RESUMEN

Bilateral trismus associated with oral cancer was commonly occurred in those who had received surgical intervention and radiotherapy. Complete release of bilateral fibrotic tissues followed by free flaps reconstruction was the main current surgical intervention. However, reconstructions of both defects mostly needed to harvest two flaps from different donor sites were time-consuming and increasing morbidities. Herein, we presented three cases who undergone modified reconstructive method by harvesting the anterolateral thigh (ALT) flap and tensor fascia latae (TFL) flap simultaneously from the same donor site. Trismus release was performed including resection of the buccal part and fibrotic tissue, myotomy of the masticatory and medial pterygoid muscles, and bilateral coronoidectomy. Case 1, a 52 years-old man, with severe trismus as the interincisal distance (IID) was about 0 mm. He undergone a combined 12 × 7.5 cm ALT and 11 × 6 cm TFL flap reconstruction from a single-donor thigh. The IID apparently increased to 37 mm after 1-year follow-up. Case 2, a 64 years-old man, went through a combination of 6 × 7 cm ALT and 6 × 6 cm TFL flap reconstruction from unilateral thigh for severe trismus. The IID significantly improved from 10 mm to 30 mm after one and a half-year follow-up. Case 3, a 53 years-old woman, with IID was around 0 mm before the surgery. A combined 9 × 3 cm ALT and 9 × 3 cm TFL flap reconstruction was performed as the IID enhanced to 20 mm after 6 months follow-up. This reconstruction method using ALT and TFL flaps harvested from a single-donor thigh simultaneously could be suitable for patients with bilateral severe trismus.


Asunto(s)
Fascia Lata , Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica , Muslo , Trismo , Humanos , Masculino , Persona de Mediana Edad , Muslo/cirugía , Colgajos Tisulares Libres/trasplante , Procedimientos de Cirugía Plástica/métodos , Trismo/cirugía , Trismo/etiología , Fascia Lata/trasplante , Neoplasias de la Boca/cirugía , Neoplasias de la Boca/complicaciones
2.
Genes (Basel) ; 15(9)2024 Aug 23.
Artículo en Inglés | MEDLINE | ID: mdl-39336700

RESUMEN

Feeding difficulties are constantly present in patients with Crisponi/cold-induced sweating syndrome type 1 (CS/CISS1). The aim of our study was to describe their prevalence and evolution from birth to adult age. We performed an observational study at the Department of Life Sciences and Public Health, Rome. Fourteen patients were included in this study (six M; mean age: 18 years; SD: 10.62 years; median age: 15 years; age range: 6-44 years); six were adults (43%). Data on oral motor abilities from birth were collected. Meal duration, presence of swallowing reflex, dysphagia symptoms, difficulty chewing, and drooling management were assessed. At birth, all patients needed enteral feeding. Introduction of solid food was postponed beyond the age of 18 months in 43% of patients. During childhood and adolescence, mealtime was characterized by increased duration (43%) accompanied by fatigue during chewing (43%), food spillage from the nasal cavities (21%), sialorrhea (86%), and poor/reduced appetite (57%). A mature rotatory chewing skill was never achieved. This report expands the phenotype description of CS/CISS1 and also improves the overall management and prevention of complications in this ultra-rare disease.


Asunto(s)
Hiperhidrosis , Humanos , Masculino , Femenino , Adulto , Adolescente , Niño , Adulto Joven , Hiperhidrosis/epidemiología , Muerte Súbita/etiología , Masticación , Sialorrea/etiología , Sialorrea/epidemiología , Deformidades Congénitas de la Mano , Trismo/congénito , Facies
3.
Medicine (Baltimore) ; 103(37): e39648, 2024 Sep 13.
Artículo en Inglés | MEDLINE | ID: mdl-39287296

RESUMEN

RATIONALE: Myositis ossificans (MO) is characterized by benign heterotopic ossificans in soft tissues like muscles, which can be classified into nonhereditary MO and fibrodysplasia ossificans progressiva (FOP). Nonhereditary MO is characterized by ossification of the soft tissues after acute or repetitive trauma, burns, or surgical intervention. FOP is a rare and crippling disease characterized by congenital malformation of the big toe and heterotopic ossification in muscle. The majority of FOP's musculoskeletal traits are associated with dysregulated chondrogenesis. The diagnosis is mainly based on clinical manifestation, imaging examination, and genetic analysis. There is still no effective treatment to cure or slow its progression. The best approach remains early diagnosis, conservative drug treatment, and injury prevention to avoid local ossification. PATIENT CONCERNS: A 34-year-old male presented at our hospital because of trismus caused by ossification of the masseter muscle. In addition, he had serious stiffness and multiple bony masses throughout the body, which led to limited movement. DIAGNOSES: Based on the clinical manifestation of movement restriction, characteristic radiographic images of ossification of soft tissues, the genetic test showing a heterozygous molecule (c.974G > C, p.G325A) of the activin A receptor type I, the patient was diagnosed as FOP complicated with localized MO in masseter after trauma and infection. INTERVENTIONS: The patient underwent the surgical resection of ossification in the masseter muscle, he was instructed to insist on mouth-opening exercises and take glucocorticoids and nonsteroidal anti-inflammatory medications after surgery. OUTCOMES: The symptoms of trismus are relieved, and eating can be basically achieved after surgery, while the symptoms of trismus recurred 2 years later. LESSONS: Although FOP has unique clinical manifestations, its diagnosis may be difficult because of its rarity. Gene analysis is the main standard for diagnosis, while patients with different genotypic variations may show different clinical symptoms. Therapeutic interventions are still supportive and preventive, and surgery is not recommended except under certain circumstances.


Asunto(s)
Miositis Osificante , Humanos , Miositis Osificante/etiología , Miositis Osificante/diagnóstico , Masculino , Adulto , Músculo Masetero , Trismo/etiología
4.
Crit Rev Oncol Hematol ; 203: 104486, 2024 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-39197668

RESUMEN

INTRODUCTION: Trismus is a potentially critical morbidity following curative-intended radiotherapy in head and neck cancer patients. However, in this setting, evidence regarding this side effect remains to be fully defined, particularly in terms of dosimetric parameters. MATERIALS AND METHODS: Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. RESULTS: This paper contains a narrative report and a critical discussion of the evidence on radiation-induced trismus in the literature, particularly the dosimetric concerns. CONCLUSIONS: The treatment goal should be to maintain high cure rates and limit the onset of complications. Further evaluations of dosimetric measures and clinical outcomes are warranted to identify patients at higher risk to target treatment tailoring.


Asunto(s)
Neoplasias de Cabeza y Cuello , Trismo , Humanos , Trismo/etiología , Trismo/epidemiología , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/complicaciones , Traumatismos por Radiación/etiología , Traumatismos por Radiación/epidemiología , Traumatismos por Radiación/diagnóstico , Radioterapia/efectos adversos , Dosificación Radioterapéutica
5.
Clin Oncol (R Coll Radiol) ; 36(10): e388-e397, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39095285

RESUMEN

AIMS: To investigate how absorbed doses to mastication structures in modern radiotherapy (RT) technique for head and neck cancer (HNC) compared with earlier RT techniques and with published trismus tolerance doses. To compare the incidence of radiation-induced trismus by earlier and newer RT techniques. MATERIALS AND METHODS: This study investigated two HNC patient cohorts treated with RT in 2007-2012 (three-dimensional conformal radiotherapy [3DCRT] and/or intensity-modulated radiotherapy [IMRT]; n =121 [Cohort 1]) and 2017-2020 (volumetric-modulated arc therapy [VMAT]; n =124 [Cohort 2]). All patients underwent RT without mastication structure-sparing intent, had normal mouth-opening ability before RT, and were prospectively assessed. Trismus was defined as the maximal interincisal opening ≤35 mm at any follow-up (3-, 6-, and 12-months post-RT). The temporomandibular joints (TMJs), masseter, and medial/lateral pterygoid muscles were delineated on the planning CT:s. Mean doses were compared between cohorts, and evaluated with respect to published trismus tolerance doses. P values ≤ 0.05 indicated statistical significance. RESULTS: Within 12 months post RT, 74/121 (61%) of patients in Cohort 1 had experienced trismus compared to 11/124 (9%) in Cohort 2. Averaged mean doses (±S.D.) for the masseter muscles were 35.2±8.3 Gy in Cohort 1 and 20.2±8.7 Gy in Cohort 2 (P <0.001). Corresponding numbers were 19.1±16.2 and 4.3±4.3 Gy for the TMJs, 53.7±10.1 and 40.2±16.8 Gy for the medial pterygoid muscles, and 29.2±18.7 and 9.2±8.4 Gy for the lateral pterygoid muscles (all P <0.001). Masseter muscle doses were below tolerance doses in 23% of patients in Cohort 1 compared with 90% in Cohort 2. The corresponding numbers were 52% and 96% for the TMJs, 8% and 36% for the medial pterygoid muscles and 72% and 100% for the lateral pterygoid muscles. CONCLUSION: Mastication structure mean doses by more recent RT techniques were generally below proposed tolerance doses, with dose reductions of 10-20 Gy compared with earlier techniques. Modern RT without mastication-structure-sparing intent resulted in below 10% of HNC patients experiencing trismus compared with 60% treated with earlier techniques.


Asunto(s)
Neoplasias de Cabeza y Cuello , Traumatismos por Radiación , Radioterapia Conformacional , Radioterapia de Intensidad Modulada , Trismo , Humanos , Trismo/etiología , Trismo/epidemiología , Masculino , Femenino , Neoplasias de Cabeza y Cuello/radioterapia , Persona de Mediana Edad , Radioterapia de Intensidad Modulada/efectos adversos , Radioterapia de Intensidad Modulada/métodos , Anciano , Traumatismos por Radiación/etiología , Traumatismos por Radiación/epidemiología , Radioterapia Conformacional/efectos adversos , Radioterapia Conformacional/métodos , Dosificación Radioterapéutica , Adulto , Masticación/efectos de la radiación , Anciano de 80 o más Años , Músculo Masetero/efectos de la radiación , Músculo Masetero/fisiopatología
6.
BMC Oral Health ; 24(1): 1018, 2024 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-39215323

RESUMEN

BACKGROUND: Limiting postoperative edema, pain, trismus, and infection is crucial for smooth healing. This prospective, controlled clinical trial investigated and compared the effectiveness of dexamethasone and hyaluronidase in relieving these complications. METHODS: In groups Ia and IIa, 8 mg of dexamethasone and 150 IU of hyaluronidase were administered following the removal of impacted teeth, respectively. The contralateral sides (groups Ib and IIb) were determined as control groups. Edema, pain, trismus, and infection were clinically evaluated on the 1st, 2nd, 3rd, and 7th postoperative days. RESULTS: 60 patients were enrolled in the study. Hyaluronidase provided significantly more edema relief than dexamethasone on the 1st, 2nd, 3rd, and 7th postoperative days (P = 0.031, 0.002, 0.000, and 0.009, respectively). No statistical difference was found between dexamethasone and hyaluronidase in VAS and rescue analgesic intake amount values for all time points. Hyaluronidase was more effective in reducing trismus than dexamethasone on the 2nd and 3rd postoperative days (P = 0.029, 0.024, respectively). Neither of the agents significantly increased the postoperative infection rate. CONCLUSIONS: Hyaluronidase can be selected when postoperative excessive edema and trismus are anticipated. Dexamethasone may be a cost-effective option if postoperative pain control is merely targeted. TRIAL REGISTRATION: This trial was registered in the Clinical Trials Protocol Registration and Results System (ClinicalTrials.gov identifier number: NCT05466604) on 20/07/2022.


Asunto(s)
Dexametasona , Edema , Hialuronoglucosaminidasa , Tercer Molar , Dolor Postoperatorio , Diente Impactado , Trismo , Humanos , Dexametasona/uso terapéutico , Hialuronoglucosaminidasa/uso terapéutico , Trismo/prevención & control , Edema/prevención & control , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Tercer Molar/cirugía , Diente Impactado/cirugía , Masculino , Femenino , Estudios Prospectivos , Adulto , Adulto Joven , Extracción Dental/efectos adversos , Antiinflamatorios/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Dimensión del Dolor , Adolescente , Infección de la Herida Quirúrgica/prevención & control
7.
Medicina (Kaunas) ; 60(8)2024 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-39202488

RESUMEN

Background and Objectives: The aim of this study was to investigate the efficacy of a single preoperative dose of deflazacort on pain, swelling, and trismus after impacted lower third molar surgery. Materials and Methods: This randomised, prospective, double-blind, split-mouth clinical study included 26 healthy individuals with bilaterally impacted lower third molars. Group 1 was given a placebo (single-dose vitamin C tablet), and group 2 was given a single 30 mg dose of deflazacort 1 h prior to surgery. Pain was evaluated using the visual analogue scale for 1 week postoperatively. Oedema (in mm) and trismus (in mm) were evaluated preoperatively and on postoperative days 2 and 7. The Mann-Whitney U test was applied for group analyses. p values < 0.05 were considered statistically significant. Results: Postoperative pain scores were significantly lower in the deflazacort group at the 6th and 12th hours after surgery (p < 0.05). There were no significant differences in trismus between the groups at any time point (p > 0.05). There was less oedema in the deflazacort group on postoperative days 2 and 7, without any statistically significant difference (p > 0.05). Conclusions: A single preoperative dose of 30 mg deflazacort was found to be clinically effective in reducing pain and oedema after extraction of impacted lower third molars.


Asunto(s)
Edema , Tercer Molar , Dolor Postoperatorio , Pregnenodionas , Diente Impactado , Trismo , Humanos , Trismo/prevención & control , Trismo/etiología , Tercer Molar/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Femenino , Masculino , Edema/prevención & control , Edema/etiología , Adulto , Método Doble Ciego , Diente Impactado/cirugía , Estudios Prospectivos , Pregnenodionas/uso terapéutico , Pregnenodionas/administración & dosificación , Extracción Dental/efectos adversos , Extracción Dental/métodos , Adulto Joven , Dimensión del Dolor/métodos
8.
Support Care Cancer ; 32(7): 470, 2024 Jun 29.
Artículo en Inglés | MEDLINE | ID: mdl-38951291

RESUMEN

PURPOSE: This study aimed to compare the effects of a mobile health intervention based on social cognitive theory with standard care on maximal mouth opening, exercise compliance, and self-efficacy in patients receiving proton and heavy ion therapy for head and neck cancer. METHODS: This open-label, parallel-group, randomized, superiority trial involved a self-developed "Health Enjoy System" intervention. We assessed maximal mouth opening, exercise compliance, and self-efficacy at baseline (T0), post-treatment (T1), and at 1 month (T2) and 3 months (T3) after radiotherapy. Generalized estimating equations were used to analyze differences between the groups over time, with results reported as P values and 95% confidence intervals (CIs). RESULTS: The study included 44 participants. At T3, the intervention group showed a 6 mm greater increase in maximal interincisal opening than the control group (mean difference = 6.0, 95% CI = 2.4 to 9.5, P = 0.001). There was also a significant difference in exercise compliance between the groups (mean difference = 31.7, 95% CI = 4.6 to 58.8, P = 0.022). However, no significant difference in self-efficacy was found between the groups. CONCLUSION: This study demonstrated that an mHealth intervention incorporating behavior change theory could effectively enhance or maintain maximal mouth opening in patients undergoing proton and heavy ion therapy for head and neck cancer in China. This approach provides valuable support during and after treatment. TRIAL REGISTRATION: ChiCTR: ChiCTR2300067550. Registered 11 Jan 2023.


Asunto(s)
Neoplasias de Cabeza y Cuello , Terapia de Protones , Autoeficacia , Telemedicina , Trismo , Humanos , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/terapia , Masculino , Persona de Mediana Edad , Femenino , Terapia de Protones/métodos , Trismo/etiología , Trismo/terapia , Radioterapia de Iones Pesados/métodos , Terapia por Ejercicio/métodos , Anciano , Cooperación del Paciente/estadística & datos numéricos , Adulto
9.
Br Dent J ; 237(2): 143, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-39060607
10.
BMJ Case Rep ; 17(7)2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38955385

RESUMEN

A woman in her 30s presented with a 12-month history of reduced mouth opening and swelling on the right side of her mandible. The swelling was non-tender and firm on palpation. The swelling began to increase in size after the extraction of her carious wisdom tooth. Histopathological and serological examinations confirmed the diagnosis of IgG4-related disease, manifested as a mass in the mandible. The patient was prescribed oral corticosteroids at a tapering dosage over 8 weeks. After 3 months, there was an improvement in the patient's mouth opening and a reduction in the size of the swelling. The patient remains in follow-up care. Including IgG4-related disease in the list of potential diagnoses for oral soft tissue masses is crucial, given their positive response to medical treatment, highlighting the significance of an accurate diagnosis to prevent unnecessary surgery, with oral lesions potentially serving as early indicators before multiorgan complications arise.


Asunto(s)
Enfermedad Relacionada con Inmunoglobulina G4 , Trismo , Humanos , Trismo/etiología , Trismo/diagnóstico , Femenino , Enfermedad Relacionada con Inmunoglobulina G4/diagnóstico , Enfermedad Relacionada con Inmunoglobulina G4/complicaciones , Adulto , Diagnóstico Diferencial , Enfermedades Mandibulares/diagnóstico , Enfermedades Mandibulares/tratamiento farmacológico , Mandíbula/diagnóstico por imagen , Inmunoglobulina G/sangre
11.
J Oral Maxillofac Surg ; 82(10): 1246-1256, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-38971179

RESUMEN

BACKGROUND: Third molar (M3) extraction is a common surgery in oral and maxillofacial surgery, and composite wound dressings such as hydroxybutyl chitosan (HBC) may improve postoperative sequala following M3 removal. PURPOSE: The study purpose was to measure and compare differences in pain, swelling, trismus, wound healing, and quality of life (QOL) between the HBC and the control sides in patients undergoing M3 removal. STUDY DESIGN, SETTING, SAMPLE: This study is a double-blind, split-mouth, randomized clinical trial. Patients who required M3 removal between June 2022 and May 2023 were included. Exclusion criteria included seafood allergies, smoking, poor oral hygiene, and systemic diseases. PREDICTOR VARIABLE: The predictor variable was the socket treatment technique. Subjects were randomly assigned to the HBC or control (physiological saline) side. MAIN OUTCOME VARIABLE: The primary outcome variables, including pain assessed by visual analog scale, swelling, and maximal incisional opening, were measured on the first, third, and seventh postoperative days. The secondary outcome variables included QOL and wound healing score measured on the third and seventh days after surgery. COVARIATES: The covariates included age, sex, and operation time. ANALYSES: The Shapiro‒Wilk test was used to evaluate the normality of the data distribution. The paired t test or Wilcoxon signed-rank test was adopted. Statistical significance was set at P < .05. RESULTS: The study included 60 patients (mean age: 25.81 ± 4.91; 23 (38%) males, 37 (62%) females). A statistically significant difference in the level of pain (HBC: 37.58 ± 4.39 mm, control: 47.00 ± 4.33 mm, day 1, P < .001; 21.88 ± 3.25 mm, 35.95 ± 1.57 mm, day 3, P < .001), maximal incisional opening (23.92 ± 1.38 mm, 18.22 ± 1.82 mm, day 1, P < .001; 30.00 ± 1.61 mm, 23.78 ± 1.70 mm, day 3, P < .001), and swelling (6.86 ± 0.70 mm, 7.15 ± 0.80 mm, day 3, P = .006) was detected after surgery. A statistically significant difference in QOL was detected (HBC: 13.70 ± 1.65, control: 18.60 ± 2.14, day 3, P < .001). CONCLUSION AND RELEVANCE: The application of HBC hydrogels to wounds after impacted mandibular M3 extraction reduces postoperative sequalae, promotes wound healing and improves postoperative QOL.


Asunto(s)
Quitosano , Tercer Molar , Complicaciones Posoperatorias , Calidad de Vida , Extracción Dental , Diente Impactado , Humanos , Tercer Molar/cirugía , Masculino , Femenino , Método Doble Ciego , Extracción Dental/métodos , Quitosano/uso terapéutico , Adulto , Diente Impactado/cirugía , Complicaciones Posoperatorias/prevención & control , Hidrogeles/uso terapéutico , Dolor Postoperatorio/prevención & control , Cicatrización de Heridas/efectos de los fármacos , Mandíbula/cirugía , Dimensión del Dolor , Trismo/prevención & control , Adulto Joven , Adolescente
12.
Dysphagia ; 39(5): 974-976, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-38922423

RESUMEN

Clinicians should consider disorders of masticatory muscle including lateral pterygoid muscle as a differential diagnosis in patients presenting with dysphagia and trismus after tooth extraction.


Asunto(s)
Trastornos de Deglución , Extracción Dental , Trismo , Humanos , Trismo/etiología , Trastornos de Deglución/etiología , Extracción Dental/efectos adversos , Masculino , Femenino , Diagnóstico Diferencial , Persona de Mediana Edad , Músculos Pterigoideos/fisiopatología
13.
Head Neck ; 46(9): 2348-2362, 2024 09.
Artículo en Inglés | MEDLINE | ID: mdl-38895913

RESUMEN

Understanding the barriers and facilitators for prophylactic swallowing and trismus exercises for patients undergoing radiation to the head and neck may help exercise adherence. The analysis reviews all published reports of exercise adherence with a critical appraisal following PRISMA guidelines. A total of 137 potential papers were identified; 20 studies met the inclusion criteria. The most commonly reported facilitators for swallowing and trismus exercises were regular clinician contact and online resources to reinforce instructions, set goals, and manage radiation toxicities. Social support and perceived benefit from exercises were also reported to be of help. The most common barriers to exercise were radiation toxicities, anxiety, feeling overwhelmed with information, and not understanding the reason for the exercises. Understanding facilitators and barriers to adherence is critical when designing exercise interventions for patients undergoing radiation for head and neck cancer.


Asunto(s)
Terapia por Ejercicio , Neoplasias de Cabeza y Cuello , Cooperación del Paciente , Trismo , Humanos , Trismo/etiología , Trismo/prevención & control , Neoplasias de Cabeza y Cuello/radioterapia , Terapia por Ejercicio/métodos , Trastornos de Deglución/etiología , Deglución , Masculino , Femenino , Traumatismos por Radiación/prevención & control
14.
J Stomatol Oral Maxillofac Surg ; 125(4S): 101944, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38852622

RESUMEN

Throat packing is essential in oral and maxillofacial surgeries to prevent blood and tissue debris aspiration, reducing postoperative complications. Traditional oral route methods are often inadequate, especially in severe trismus cases like Oral Submucous Fibrosis (OSMF), TMJ Ankylosis, and post-traumatic conditions due to limited mouth opening. This study introduces a novel technique using a nasopharyngeal airway (NPA) for throat packing. The method involves inserting a hemostatic dressing through an NPA, ensuring minimal invasiveness and effective airway management. Proper positioning is confirmed with a laryngoscope or fiberoptic scope, and the dressing is secured to prevent dislodgement. This technique is easy, reproducible, and less injurious compared to traditional methods. At our center, throat packing via NPA was performed on 35 patients undergoing surgery under general anesthesia, resulting in high satisfaction and no reported complications.


Asunto(s)
Anestesia General , Trismo , Humanos , Trismo/cirugía , Trismo/etiología , Trismo/terapia , Anestesia General/métodos , Masculino , Femenino , Faringe/cirugía , Adulto , Persona de Mediana Edad , Nasofaringe/cirugía , Vendajes
15.
BMC Oral Health ; 24(1): 716, 2024 Jun 22.
Artículo en Inglés | MEDLINE | ID: mdl-38909199

RESUMEN

BACKGROUND: Isaacs' syndrome, also known as neuromyotonia or peripheral nerve hyperexcitability, is a rare disorder that affects the peripheral nervous system. Clinical findings include cramps, fasciculations, and myokymia; however, there are few reports of dental treatment for trismus. CASE PRESENTATION: A patient with trismus due to Isaacs' syndrome experienced swelling and pain in the gingiva surrounding his right lower first molar. He was diagnosed with chronic apical periodontitis by a dentist near his home. However, the patient was informed that dental treatment and medication could not be administered because of the presence of Isaacs' syndrome, and he visited the Geriatric Dentistry and Perioperative Oral Care Center at Kyushu University Hospital 2 weeks later. The patient's painless mouth-opening distance (between incisors) was 20 mm at that time, and medication, including amoxicillin capsules and acetaminophen, was administered because the dental extraction forceps or endodontic instruments were difficult to insert into the oral cavity for treatment. Two months after his initial visit, the patient visited us complaining of pain in the same area. However, he had recently undergone plasmapheresis treatment in neurology to alleviate limited mouth opening and systemic myalgia, resulting in a pain-free mouth-opening distance of approximately 35 mm. During this temporary period in which he had no restriction in mouth opening, we performed tooth extraction and bridge restoration on the mandibular right first molar and created an oral appliance for sleep bruxism. CONCLUSIONS: Plasmapheresis therapy transiently reduced trismus, rendering dental interventions feasible, albeit temporarily. This case report underscores the importance of close collaboration between neurologists and dentists who encounter similar cases while furnishing valuable insights to inform dental treatment planning.


Asunto(s)
Trismo , Humanos , Masculino , Trismo/terapia , Trismo/etiología
16.
J Evid Based Dent Pract ; 24(2): 101983, 2024 06.
Artículo en Inglés | MEDLINE | ID: mdl-38821660

RESUMEN

OBJECTIVES: The extraction of third molars is one of the most performed surgical procedures in oral and maxillofacial surgery. Pain, oedema, and trismus are the most frequently complications related in the surgical postoperative period. The literature has indicated PBM as a potential adjuvant method to reduce these complications. The aim of this review and meta-analysis is evaluate the PBM, as an optimal method to improve patient experience and minimize postoperative morbidity. Additionally, we seek to determine which wavelength, site, and frequency of application are most effective. METHODS: This review was registered in PROSPERO (CRD42023429966) and followed PRISMA guidelines. The search was carried out in the main databases, PubMed/MEDLINE, Cochrane Library, Embase, Scopus, and Lilacs, including reviews in the most important journals in the area of oral surgery and laser applied to oral surgery. In addition, all article references and also gray literature were reviewed. After the studies selection, the relevant data was collected. All the studies were randomized controlled trials and the patients were allocated into two groups: active PBM and inactive PBM. The statistical analysis was carried out using Stata v.16, and the methodological quality and risk of bias were assessed by the Jadad scale and RoB 2.0, respectively. RESULTS: Where included 22 studies and 989 subjects, to all with a minimum follow-up of 7 days. Pain and oedema showed statistically significant results in favor to the active PBM group. Especially when laser applied in infrared mode, for pain and oedema at 48 h, MD = -1.80 (CI95% -2.88, -0.72) I²â€¯= 92.13% and MD = -1.45 (CI95% -2.42, -0.48) I²â€¯= 65.01%, respectively. The same is not true for trismus at 48 h, MD = 0.07 (CI95% -0.06, 0.21) I²â€¯= 3.26%. The meta-analysis also presented results in respect of laser site of application and number of PBM sessions. CONCLUSIONS: PBM with infrared laser, in a combination intraoral and extraoral application, in one session in the immediate postoperative period, has been shown to be effective to achieve the objectives of reducing pain and oedema after third molar extraction.


Asunto(s)
Edema , Terapia por Luz de Baja Intensidad , Tercer Molar , Dolor Postoperatorio , Complicaciones Posoperatorias , Extracción Dental , Humanos , Tercer Molar/cirugía , Terapia por Luz de Baja Intensidad/métodos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Edema/prevención & control , Edema/etiología , Complicaciones Posoperatorias/prevención & control , Mandíbula/cirugía , Trismo/prevención & control , Trismo/etiología
17.
Am J Med ; 137(9): e167-e168, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38649002
18.
Quintessence Int ; 55(5): 380-390, 2024 05 30.
Artículo en Inglés | MEDLINE | ID: mdl-38619256

RESUMEN

OBJECTIVES: This study examined the impact of injectable platelet-rich fibrin (iPRF) and concentrated growth factor on postoperative pain, edema, trismus, and quality of life in impacted mandibular third molar surgery. The primary aim of this study was to minimize common sequelae following third molar surgery by using iPRF and concentrated growth factor. The secondary objective was to compare the postoperative effects of these products. METHOD AND MATERIALS: This study represents a single-center, randomized prospective clinical trial conducted at the Ordu University Faculty of Dentistry. It involved patients who underwent third molar surgery for various reasons between July and October 2022. The predictor variables were the use of concentrated growth factor and i-PRF. They were categorized as concentrated growth factor, i-PRF, and control groups. The outcome variables include pain levels and analgesic consumption measured on a visual analog scale, distances between predetermined anatomical points, maximum mouth opening capacity, and data from the postoperative symptom severity (PoSSe) scale. Some statistical tests were performed with a 95% confidence interval, which was considered significant. RESULTS: Total analgesic use was notably lower in the concentrated growth factor group (P = .044). Concentrated growth factor and iPRF outperformed the control group in all edema measurements by postoperative day 7 (tragus-pogonion, lateral canthus-angulus, tragus-commissura; P < .05). Concentrated growth factor significantly reduced trismus on days 2 and 7. Quality of life was notably higher in the concentrated growth factor group than in the control group (P = .026), although iPRF group differences were not significant. CONCLUSION: The results indicate that concentrated growth factor has a limited impact on postoperative pain, but significantly reduces edema, trismus, and enhances quality of life. The iPRF group experienced positive effects on pain, edema, and trismus, although the statistically significant differences observed with concentrated growth factor highlight its potential for use instead of iPRF after third molar surgery. An increased sample size is essential for more comprehensive results.


Asunto(s)
Edema , Tercer Molar , Dolor Postoperatorio , Fibrina Rica en Plaquetas , Calidad de Vida , Diente Impactado , Trismo , Humanos , Tercer Molar/cirugía , Diente Impactado/cirugía , Femenino , Masculino , Estudios Prospectivos , Dolor Postoperatorio/prevención & control , Adulto , Edema/prevención & control , Edema/etiología , Trismo/prevención & control , Trismo/etiología , Complicaciones Posoperatorias/prevención & control , Extracción Dental , Dimensión del Dolor , Péptidos y Proteínas de Señalización Intercelular/uso terapéutico
19.
Sci Rep ; 14(1): 8828, 2024 04 17.
Artículo en Inglés | MEDLINE | ID: mdl-38632471

RESUMEN

The aim of this split-mouth randomized clinical trial was to evaluate the clinical outcomes (operative time, edema, trismus, and pain), the immediate histological effects, the alveolar repair (2 and 4 months), and the quality of life after the extraction of impacted third molars using high-speed pneumatic and electrical rotation. Sixteen patients underwent extraction of the two mandibular third molars with a minimum interval of 15 days. On one side of the participant's mouth, high-speed pneumatic rotation was used (Control Group-CG) while for the other side, high-speed electrical rotation was used (Study Group-SG). Statistical analysis included ANOVA repeated measures and Pearson correlations. SG group showed: shorter operative time (p = 0.019), less pain (p = 0.034), swelling (p < 0.001) and trismus (p = 0.025) on the 1st postoperative day; less pain (p = 0.034) and trismus (p = 0.010) on the 3rd postoperative day; less trismus (p = 0.032) on the 7th postoperative day; and better quality of life (p = 0.007). No differences were observed for peripheral bone damage or bone density of alveolar repair at 2 and 4 months between groups. Electric high-speed rotation provided better postoperative clinical parameters of pain, edema and trismus when compared with pneumatic high-speed rotation for mandibular third molar surgery.Trial registration: Brazilian Registry of Clinical Trials registration number RBR-4xyqhqm ( https://ensaiosclinicos.gov.br/rg/RBR-4xyqhqm ).


Asunto(s)
Tercer Molar , Trismo , Humanos , Tercer Molar/cirugía , Rotación , Estudios Prospectivos , Calidad de Vida , Dolor Postoperatorio , Extracción Dental , Boca , Edema
20.
ScientificWorldJournal ; 2024: 9304671, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38633105

RESUMEN

Objective: To evaluate the profile of patients operated for maxillofacial space infections and associated risk factors for the length of hospital stay. Materials and Methods: We conducted a retrospective study among patients operated for maxillofacial infections at our center from 2010 to 2020. Information collected from the records were age, sex, type and number of spaces involved, clinical signs and symptoms (pain, swelling, toothache, sore throat, otalgia, hoarseness, headache, cough, neck swelling, rancid breath, sialorrhea, gingival swelling, muffled voice, trismus, fever, dysphagia, odynophagia, malaise, lymphadenopathy, dyspnoea, pus discharge), treatment modality, total leukocyte count, evidence of bacterial growth, comorbidities, complications if any and length of hospital stay. Results: A total of 128 medical records were examined, out of which 59 were female. The mean age was 38.59 ± 19.7 and the length of hospital stay was 7.56 ± 3.8 days. The most commonly involved space was submandibular space (46.1%) and the common symptoms reported were swelling (99.2%), pain (86.7%), and trismus (68%). Four patients had complications like necrotizing fasciitis (1.6%), pneumonia (0.8%), and death in one patient (0.8%). Logistic regression showed that patients more than 36 years of age, male sex, evidence of bacterial growth, and diabetics had higher odds of increased hospital stay (>6 days). Multiple logistic regression analysis showed that age (P = 0.015; OR: 2.98) and evidence of bacterial culture (P = 0.001; OR:6.64) were potential predictors associated with increased hospital stay. Conclusion: Our study showed that the age of the patient and evidence of bacterial culture were potential predictors of prolonged hospital stay among patients operated for maxillofacial space infections.


Asunto(s)
Cefalea , Trismo , Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Recién Nacido , Estudios Retrospectivos , Factores de Riesgo , Dolor
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